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BATHS: HYGIENIC AND MEDICINAL, Their Effect Upon the Skin and General System
After a general explanation of the effect of water, hot and cold, upon the skin and so upon cleanliness and bodily well-being, a detailed account is given here of the many kinds of baths used in purification (q.v.), medical treatment and of the particular action of each kind.
The practice of bathing is of very early origin, and among the ancients was often associated with religious rites, bodily and spiritual purification, and ceremonies. Remains of baths in connexion with temples have been found in India, Persia, Egypt, Turkey, Mexico, and Assyria; the Nile and the Ganges were both sacred rivers; the Mosaic law prescribed bodily ablutions on many ceremouial occaaions. In Greece, bathing was extensively followed; Homer speaks of the practice of taking warm baths after fatigue or severe exercise; public baths existed in Athens and other cities, and baths in private houses were common.
It was among the Romans, however, that bathing was developed to its fullest extent and from where we get the origin of the word spa. At first cold swimming pools were constructed but later the use of hot water became very popular, and elaborate bathing establishments were built in Rome and other cities. Various emperors constructed enormous buildings in their desire to please the populace. Many of these were equipped with gymnasia, and even theatres and libraries. Among the best known are the baths of Domitian, A.D. 95; Caracalla, 217; and Diocletian, 302; the ruins of which still bear witness to the magnificence of the time. They contained swimming baths, warm baths, hot air baths and vapour baths. The baths of Caracalla are estimated to have held more than three thousand marble seats for bathers. In the largest baths there was a stadium for games, courts for amusements, gardens, shops, and colonnades in which philosophers and literary men met.
 
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The bathing was an elaborate process, and the richer Romans employed a great variety of oils and pomades. At first separate baths for the two sexes were built but later they bathed together. Wherever the Romans went they carried with them their practice of building baths, and at Bath (q.v.) England possesses one of the finest relics of Roman culture in northern Europe. About the fifth century they fell into disuse, but were continued at Alexandria, and were also employed by the Mohammedans and the Arabs in Spain.
The Knight Crusaders (Hospitallers) spread the use of baths in Europe for medicinal purposes, and hot vapour baths were employed for the cure of leprosy by the Kinghts of Lazarus; but during the Middle Ages bathing was little resorted to due to religious taboos, and even as late as the eighteenth century public baths were practically unknown in Europe, many of the great private houses in Britain had no bathrooms and few people took baths regularly. In Great Britain the Public Baths and Washhouses Act passed in 1846 first authorised local authorities to provide public institutions for bathing and hygiene.
From that time onwards the provision has steadily increased, and now virtually every town of any importance possesses its public baths if not spas.
The Hygiene of the Bath
Personal cleanliness became more and more recognized as a valuable aid in maintaining good health during the 19th century. Yet it is important that certain rules and procedure should be observed and haphazard bathing without regard to the time of the bath or the temperature of the water may be actually injurious, particularly in the case of young children or invalids. Baths act primarily on the skin, but through the skin they exercise an influence upon the blood and its circulation, the internal organs, and the nervous system generally. The skin, besides being a protective covering to the body, is also in effect a very important excreting organ, and through the sweat glands it gets rid of a large quantity of waste material which is conveyed in the small blood vessels to the surface of the body. The cells of the deeper layer of the skin are constantly passing ontwards to the superficial layer, where they are shed in the form of dry, dead scales. The action of water, particularly when aided by soap and vigorous rubbing is to remove dirt, to assist the detachmentof the loose scales, and to remove material which is obstructing the sebaceous or sweat glands, and in this way enable them to function actively. The enormously benefits the elimination function of the kidneys and liver.
Cold Baths
The application of cold water to the skin causes the minute blood vessels to contract; the amount of blood in the internal organs's increased, and the heart is stimulated. A brief immersion is sufficient, and should be followed by a brisk towelling off and some form of brisk physical exercise. The initial chill should be quickly succeeded by a warm, exhilarating glow, and if this is not felt cold baths should not be taken as the resistance is weak (q.v. Cold). A cold morning "tub," in water at a temperature between 32 and 60˚ F., is stimulating and refreshing, but as a rule should only be taken by healthy young adults. After middle age it is wise in very cold weather to add a little warmer water so as to "take the chill off." The habit of taking cold baths increases the adaptability of the body to changes of temperature and the power of resisting cold, hence diminishing the likelihood of catching cold, especially when followed by brisk massage of the whole body with the palms of the hands.
Cold baths are not suitable for young children or for people of delicate constitution. It is unwise to take a cold bath when one is very hot or immediately after violent exercise. In these circumstances the skin is engaged in reducing the overheated condition of the body by active transporation of water, and the effect of the cold in causing the minute blood vessels in the skin to contract is to interfere with this process and drive the blood into the deeper parts of the body.
Hot Baths
Hot baths cause the superficial blood vessels to expand and exercise a stimulating influence upon the sweat glands. The action of the heart is quickened, the temperature rises, and there is an increase in the activity of the tissue changes in the body. the action of such a bath is at first stimulating, but if continued too long it becomes depressing. Hot baths should be avoided by persons suffering from heart disease, and should not be taken soon after a full meal.
Frequent hot baths are debilitating, as the congested state of the skin following the bath persists for a considerable time, and causes an undue loss of bodily heat. If the hot bath is succeeded by a cool or tepid shower or sponaing this cffect is checked. For ordinary purposes the temperature of a warm bath should be in the neighbourhood of 100˚ F. It is rarely desirable to exceed that of 105.
As regards frequency, the daily cold or moderately warm bath is the ideal. Where this is not practicable, a warm bath should be taken at least twice a week. The practice of providing baths for children in schools is steadily increasing, and has been found to exercise a very beneficial effect upon their health. A rain bath or douche is often used, as it has been found to be more cleansing and economical of water.
Smokh   ENTERING THE DEEP BATH
A method of treatment at Bath and other spas is by means of the deep bath, into which
helpless patients are lowered.
Baths in Therapeutics
Water baths for medicinal use are divided into those of complete and of incomplete immersion. They are again divided into cold, tepid, warm, and hot; into still and aerated, plain and medicated, natural and artificially prepared. In another group are mud and paraffin baths and local or general packing.
In discussing the general effects of baths several factors call for consideration. These are influence upon:
  • The structures of the skin itself,
  • Tthe indirect influence upon the heart,
  • Blood pressure and respiration;
  • The influence upon metabolism, muscle tone, fibrous tissue and joints; and
  • The effect of elimination of poisons through the skin. These effects are closely intermingled and are to a large extent interdependent.
Use has been made of the cooling effect of baths in treatment of certain ferbrile states, notably the hyperpyrexia of sunstroke, influenza and typhoid fever. For this purpose the whole body is immersed in cool water for a period not exceeding twenty minutes, or utitil the temperature taken in the rectum has fallen to within two degrees of normal; as a result of such immersion the temperature continues to fall and longer exposure is dangerous.
With regard to the effect upon the heart, a cold bath slows the pulse, a hot bath quickens it and is a powerful dilator of the blood vessels, lowering the blood pressure and speeding up the circulation throughout the body.
Metabolism is greatly influenced by baths. The shock of a cold bath in the healthy individual promotes a greatly increased use of oxygen and output of carbonic acid. Prolonged exposure to a low temperature has a reverse effect. Muscle tone is altered consider ably by warmth and cold; it has been shown by experiment that one effect of moderate cold is to delay the appearance of the fatigue curve time line continuously acting muscles. Fibrous and muscular tissues are markedly influenced by baths; indeed it is in faulty conditions of these that baths find their widest field of usefulness. Warmth relaxes stiffened ligaments and tendons, and the support of the water allows weakened limbs to perform movements that may otherwise be impossible.
The nervous system is profoundly influenced by baths; it may be stimulated by short spells of heat or shorter spells of cold; it may be soothed by longer immersion in a tepid bath or by the gentle friction of air bubbles breaking on the skin surface. This is a very valuable means of combating sleeplessness or the restlessness of chorea (q.v.).
Immersion baths may be cold, i.e. at any temperature up to 85˚ F.; tepid, between 85 and 98°; warm, between 98 and 104°: hot, between 104 and 110°.
Aerated baths are similar, but have the addition of air bubbles frothing in the water. They owe their increased effect to the gentle stimulation of the skin by the bursting of these bubbles upon the surface, and to the fact that, gas being so much interior to water as heat-conductor, the skin is exposed to a constant succession of small changes of temperature as the bubbles form and burst. These baths are extensively used in cases of heart weakness and neurasthenic conditions.
Douches internal and external form a useful part of balneotherapy. They are dealt with in detai! under then own heading. Rectal and colonic lavage by means of the Plornbieres douche is a valuable treatment for chonic intestinal stasis (q.v. douches ). The scotch douche is carried out by means of two forcible streams of water, hot and cold.
The Vichy douche is given to a patient while in the recumbent position under a gentle rain of water it is combined with general rnassage. The Aix douche is given by directing a forcible sttearn of water from a hose upon the body of the patient seated or lying on a table, while vigorous massage is carried out. The under-water douche consists of the application of a stream of water upon any desired area of the body while immersed in water. Its main sphere of usefulness is in the treatment of stiff joints.
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MINERAL WATER BATH TREATMENT
An effective method of administering treatment for stiff joint conditions is under-current hot douching at high pressure while the patient lies in a mineral water bath.
 
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BATHS: TWO MODERN FORMS OF TREATMENT
Above a patient supported in a horizontal sling is given re-educative limb movements in the hot bath Old Royal Baths at Bath. Below a modern sedative mineral bath for nerve conditions the body being covered in foam produced by carbonic acid gas. Foam therapy induces perspiration and stimulates the skin gently.
Spray baths in which the patient is exposed to the action of fine streams of water at a temperature and force which can be controlled at will, are very often employed as a means of toning up the skin after it has been exposed to the relaxing influence of heat. The most useful form is the needle bath in which the body is sprayed from fine jets on all sides at once.
Steam and vapour and hot dry air baths have been used for many centuries and the former are still the customary baths of the peasantry of Finland, Rusaia and Scandinavia.
Whirlpool Bath
In this treatment the water is kept rapidly moving in with a steady; whirlpool motion. It is useful for atiff joints and muscles and rheumatic conditions. Turkish baths (q.v.) are very useful in the treatment of chronic rheumatic affections lumbago. sciatica, neuritis, fibrositis and general toxic conditions. Their effects are achieved by raising the body tamperature and at the same time exciting copious perspiration.
Hot blanket baths, described under the heading Hot Pack, have a similar action, but their effect is not so intense. In such a pack the body temperature rises 2 or 3 degrees, the pulse rate is quickened and breathing becomes more rapid; at the same time free perspiration is induced and much poisonous matter is got rid of.
Cold packs given on similar lines to hot packs are sometimes used to allay fever induce sleep and calm excitement and are also used to strengthen the heart and allay inflammation in the deeper tissues in certain cases.
Before leaving the subject of baths as therapeutic agents it is well to direct attention to possible ill-effects which may follow.
As a result of hot baths a condition of discomfort, malaise, or even definite ill-health sometimes arises, signifying that toxic products are being stirred up quicker than they are being dissipated by the channels of the skin. The remedy is to diminish the temperature, duration and frequency; until the necessary adjustment has been made by the body. Children and old people do not stand vigorous thermal treatment well, and of course very special caution must be exercised in all cases where thera is any heart weakness or impaired function of the kidneys.
Smokh   BATHS: MUD PACK FOR RHEUMATIC OR STIFF JOINTS
The mud which may be obtained either from abroad or from local supplies such as those near Bath, is mixed with minerat water and applied, in the form of hot packs, to relieve inflamed or thickened joints. This treatment is generally followed by a spray douche.
Other Medicinal Baths
Medicated bath may be natural or they may be artificially prepared. There are a very large number of these, and the distinctions between them are sometimes more trivial than their partisans admit.
Bran Baths. This form of bath is used occasionally for its soothing effect in certain skin diseases associated with irritation and extreme sensitiveness. Its virtue lies not so much in the general influence of the warm water in which the patient is immersed as in the opportunity it affords of applying closely and painlesly to inflamed skin a smooth nonirritating dressing, which, in addition to its soothing qualities, has a slight antiseptic action.
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HYDRO-ELECTRIC BATHS AS A GENERAL TONIC. The combination of electrical current with baths enhances their tonic and sedative effects. The full body bath (below) is placed on insulating pegs and the current is supplied by eight electrodes. The £our-cell bath (above) originated by Dr. Schnee, consists of four porcelain baths etectrically connected those for the arms being
adjustable in any direction.
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The bath is prepared by adding fresh bran in the proportion of two pounds to ten gallons of water at a temperature of l03˚ Fahrenheit; this is most conveniently done by first making a thick paste with hot water and bran, added in small quantities and stirred vigorously; just before the patient enters the bath this paste is slowly poured into the bath and intimately mixed with it. The duration of the bath should not he less than thirty minutes, and may with advantage be considerably longer, but it is necessary to maintain the temperature at approximately the same level throughout by the frequent addition of fresh supplies of hot water.
Electric Baths
Treatment by electric baths has its advocates and in skilled hands is capable of doing good in suitable cases, although simpler methods of applying electricity to the body are now generally employed. The electric bath consists of a warm water bath made of porcelain, earthenware or some other non-conducting material in which the patient can lie at full length; it is provided with large electrodes at either end, through which is passed an electric current, usually galvanic but occasionally faradic or sinusoidal. A delicate meter must be inserted in the circuit, and, as a precaution a sensitive fuse must never be omitted. After the patient has taken up a comfortable attitude in the bath the current is turned on very gradually, at the termination of the treatment it is gradually turned off.

These baths are employed for their effect in certain cases of impaired circulation, as shown by chilblains and"dead" fingers, chronic rheumatism and allied conditions.
Mud Baths
The material used for these baths is dried mud obtained from volcanic regions in New Zealand, Northern Italy; or Central Europe, or local supplies. It contains a large amount of mineral matter in a finely divided form, and is usually impregnated with sulphur and microbes. Some of these muds are definitely radio-active. The mud is sold commercially in dry form and just before use is heated and moistened till it is of a thick pasty consistency, this paste is thickly applied to the part of the body needing treatment, or may be spread over the whole surface. The patient is then wrapped in towels or sheets and remains in the mad envelope for a period of 1/2 to 1-1/2 hours. The mud is then washed off with a spray or shower, and the skin is rapidly dried. Mud baths are used principally for chronic irritation, skin affections, and for the relief of rheumatic or painful joints following injury.
BRINE BATHS.
There are several spas in Great Britain and on the Continent the waters of which owe their curative value to a high content of common salts. At Droitwich (q.v.), which has the distinction of being the strongest saline spa, the concentration of salt reaches the striking figure of 30 per cent., that is, ten times the strength of sea water. Other salt waters in Great Britain are Woodhall Spa, Cheltenham, Leamington and Bridge of Allan.
Brine waters are used chiefly as direct surface remedies for skin conditions, but they are also of value in the treatment of chronic affection of the joints and muscles; in the buoyant brine, movements of stiffened and weakened limbs which cannot be attempted without some support become possible, and in combination with massage and training these baths form a very useful method of promoting return of function after disabling injuries. A substitute for the natural bath can be prepared at home by the addition of one pound of rock salt to five gallons of water.
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DROITWICH: ONE OF THE BRINE SWIMMING BATHS FOR MEN. Treatment at Droitwich takes the form of baths only, for the waters are too strong to be drunk. The brine swimming baths, of which there are three, are kept at a temperature of about 90˚ F. In addition to their saline constituents the waters possess marked radio-activity. Rheumatism, lumbago, gout and local deformities are some of the conditions benefited by the brine.  
 
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