mersed and rapid friction given. This treatment lasts ten to twenty seconds. Reaction should promptly take place. This treatment is a strong tonic and is usually given in the morning.

In a half bath the tub is filled about one third or one half with water, a sufficient amount to cover the extended limbs and pelvis. The temperature should be 60° to 65° F. The patient sits in the bath while the nurse splashes the water over the body and gives friction. The patient may also assist in the rubbing. A bath mit or brush may be used in giving friction. This treatment may last from one to ten minutes, depending on the condition of the patient.

Cold foot baths are sometimes given when the circulation is sluggish and in cases of insomnia and neurasthenia. The feet are placed in a tub of water 50° to 60° F. and vigorously rubbed and dried with coarse towels.

A prolonged warm bath is often given to relieve fatigue, reduce nervous tension and induce sleep. The tub is filled two thirds with water at 90° to 100° F. The patient should recline and be encouraged to relax. The treatment may continue for twenty minutes. When ready to be taken out, a cool spray or sponge may be given, after which the patient is rubbed dry, gowned, wrapped in a blanket, placed in bed and given a warm drink. The room must be quiet and well ventilated, the lights turned low and conversation should not be permitted.

The continuous bath is largely employed in the treatment of delirium and the excitement of mania. Some tubs are so constructed that there is a continuous inflow of water at a constant temperature, but this treatment can be given in an ordinary bath tub, and the temperature of the water can be maintained by the addition of hot water from time to time. A hammock or canvas straps are adjusted in the tub so the patient can recline and the whole body be immersed in the water. Sometimes the hammock is of coarse material, and a mattress protector or sheet should be placed over it and securely fastened or pinned to it to prevent its slipping.

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The tub is then filled with water about 98° F. or lower as prescribed by the physician. The patient is lightly rubbed with lanolin, especially the heels, soles of the feet and palms of the hands; a gown is put on, or if the patient is very restless pajamas are better; cotton is placed in the ears to exclude the water; a bathing cap may be put on to protect the hair; a rubber ring encased in a pillow slip is placed under the head; the feet are elevated to keep them as much as possible out of the water, and the tub is covered with a rubber sheet and a small spread or sheet which are neatly folded about the tub and pinned in place; water is given freely to drink, and the patient should never be left alone. A bath thermometer should always be kept in the tub and the temperature of the water frequently read, even where the control is automatic, for thermostats are not always to be depended upon. The pulse is taken often, and charted. The patient remains in the tub usually about eight or nine hours, but some cases are kept in for twenty-four hours. When taken out a cleansing bath is given, the body is thoroughly dried and rubbed with alcohol, and the patient is placed in a warm bed. This treatment in many cases does away with the necessity for giving sedatives and hypnotics, for the patient invariably becomes less restless and many times quiet and drowsy, and refreshing sleep usually follows.

The Brand bath receives its name from Dr. Brand, who first advocated its use and demonstrated its value. It is largely employed in typhoid fever and other febrile disorders. When it is used a temperature of 102.5° or 103° F. is usually an indication for the bath. The procedure is: A portable tub two thirds filled with water at a temperature of 70° to 85° F. as prescribed by the physician is placed alongside the bed. A hammock or other means of support is placed in the tub. The patient is covered with a sheet, the gown is removed, cotton is placed in the ears and she is then lifted from the bed and gradually lowered into the tub, until the shoulders, chest and whole body are immersed.

A rubber ring or pillow is placed under the head, and cold compresses are applied. As soon as the bath begins, friction to all parts except the abdomen should be given and continued throughout the treatment. The rubbing should follow the venous circulation - always towards the heart. Some patients are not able at first to stand a low temperature, so the water may be started at 90° F. and gradually reduced by the addition of ice. The duration of the treatment is from ten to twenty minutes. The pulse is taken occasionally, and more frequently if there is cyanosis. At first it becomes hard and small, due to the increase in arterial pressure; the respirations are gasping, and muscular tremors are usually present. If at any time the pulse becomes weak, rapid or irregular the treatment must be terminated at once, and stimulation by heat and friction given. The bed is made ready to receive the patient by spreading a rubber sheet over it and covering with a bath blanket. In some cases the bath blanket is omitted. At the end of the bath a dry sheet is placed over the tub, and as the patient is lifted from the bath she is wrapped in it, the wet sheet having been withdrawn, placed in bed and the bath blanket folded about the body. At the expiration of ten or twenty minutes the sheet is removed and the skin is dried if necessary; the bed is remade, and the temperature is then taken. If reaction does not set in after the patient is placed in bed, the friction should be continued and hot water bags should be applied to the extremities. The effects of this treatment are many. The temperature may show a drop of one or more degrees, the mental symptoms are often much relieved, the pulse is slowed and the heart action is stronger, more oxygen is inhaled and CO2 is exhaled (some authorities state as high as three times the normal amount) and the activity of the kidneys and skin is increased.

Sitz baths are given locally to the pelvis, in a tub of special construction. Depending upon the action desired these may be hot, cold, neutral or prolonged. A blanket is placed about the patient and pinned at the back of the

neck; she is then seated in the tub, and the feet placed in a foot bath at a temperature of 105° to 110° F. The upper edge of the blanket is brought up around the shoulders and over the edge of the tub, and the lower edge covers the foot bath. A folded towel is placed at the back of the tub to protect the patient from contact with it, and another is placed over the front under the knees. Care must be taken to avoid pressure on the popliteal space.

In the cold sitz bath the patient sits erect in the tub, the feet in the foot bath; the edges of the blanket are separated and placed on the shoulders; water is dipped from the tub and applied with friction to the back, the patient at the same time giving friction to the abdomen. Bath mits may be used for the rubbing. When a hot sitz bath is given, the temperature is gradually raised to the prescribed degree, an ice bag or iced compresses are placed on the head, and the water in the foot bath should always be several degrees higher than the temperature of the bath.

Drip or rub sheet bath. The patient stands in a tub in which water at 105° F. covers the ankles. The nurse takes the upper corner of the sheet in the left hand while the right hand gathers up the border of the sheet from left to right into folds, then dips it into the water and when saturated applies it as follows: The patient raises both arms, the nurse holds the left corner under the right axilla and draws the sheet across the chest; the arms are lowered to the sides, the sheet is carried well up over the shoulders and encircles the neck, and the corner is tucked in to prevent slipping; the lower border is wrapped about the legs. Water at a temperature of 65° to 75° F. is dashed on the chest and back; the nurse standing at the side gives vigorous friction and slapping to the back and chest at the same time; the sides and the arms and legs are treated in like manner. The sheet is then withdrawn, the patient steps out of the tub on to a bath rug, is thoroughly dried and rubbed briskly with warm towels. This treatment is used in neurasthenia and to relieve insomnia.

The salt glow is a vigorous circulatory stimulant. Inasmuch as no great amount of cold water is applied to the body it does not require as great reactive power as other cold treatments. Its general effect is tonic and sedative. About two pounds of coarse salt are moistened with cold water and allowed to stand for a short time. The treatment should be given in a wet room or bath tub. A towel is pinned about the waist and the patient stands in a tub in which water at 105° F. covers the ankles. Each section of the body as it is treated is moistened with water from the tub, or the entire body surface may be moistened by immersion or spray at a temperature of 100° to 105° F. Standing in front of the patient, take a small amount of the wet salt in each hand, spread it evenly over the neck and chest, give vigorous alternate circular friction of the neck and cross-stroking to the chest, until the skin is in a glow; next give circular friction to the sides of the chest and cross stroking to the abdomen; with one hand on each side of the left arm give circular friction, and follow the same procedure with the right arm and the legs; stepping behind the patient, give circular friction to the hips, alternate circular friction to the back of the neck, cross-stroking to the shoulders, to and fro friction to the back, and finish with longitudinal stroking to the spine. The salt should be thoroughly washed off by means of water poured from a pail, or by shower or general spray. Dry the patient with towels or by wrapping in a sheet as after any general wet treatment.