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The best way to apply a lotion to the eye in ordinary cases of conjunctivitis is by means of an eye bath. This should be madc of glass and filled with warm boracic solution. The patient leans forward over a basin and applies wthe eye to the eye bath, which should fit closely to the lids, which are kept as widely open as possible; then, keeping the eye bath in close contact with the margin of the orbit of the eye, the head is raised and held backwards so that the lotion washes the front of the eyeball and the conjunctival sac. The eye may be opened and closed several times. Still heeping the bath in position, the head is lowered over the basin. If there is much discharge, other methods of irrigation should be used.
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Warm boracic lotion is best applied to the eye by means of a specially shaped glass cup. This fits closely round the lids and prevents any spilling of the lotion.
he principle underlying the treatment is to subject the surface of the body to the contact of innumerable air bubbles at a raised temherature. The foam is usually made by pumping air or some other gas such as oxygen or carbon, dioxide into water in which is contained an emulsion of quillaia bark or some allied substance. The bath becomes filled with a mass of what look like soap suds, in which the whole body is immersed. They can be combined with special mineral waters when available and are mainly sedative in effect. The treatment is of benefit in rheumatic affections, nerve disorder, muscular stiffness, and some cases of heart disease.
A modern development of water therapy is the foam bath, of which several varieties are in use. Here, at the Berlin University Institute for Water Cure, a foam produced from a special soap solution by oxygen and carbonic acid gas is under test.
Applications of mud in the form of local or complete baths are of value in the treatment of certain forms of obstinate skin diseases and in chronic rheumatic affections of the muscles and joints. Some mud used for these purposes has strong radioactive properties to which its healing action may be partly due; other muds are the habitat of low forms of vegetable life and derive their power in part from the changes that these induce in the material used, other possess unusal microbic activities which may confer some form of immunological stimulation.
The mud of Dax, near Biarritz, is a volcanic, oily substance from the banks of the Adour and is mixed with hot radio-active spring water. It may be applied to the whole body or to some local part, and is beneficial to cases of chronic rheumatism, stiff joints, lumbago and neuralgia.
The mustard bath in the proportion of an ounce of mustard to each gallon of hot water has long been a familiar and useful form of home treatment for cold in the head, the fevers of children and in cerebral congestion. By dilating the cutaneous vessels of the body it relieves blood pressure in the viscera and acts as a stimulant to the heart and to respiration. In cases of painful menstruation a mustard sitz bath often brings immediate relief.
Peat, which is the product of slow decomposition of mosses and other swamp plants is a material containing a high percentage of mineral salts; iron is a constituent of most varieties; sulphur is present in many and usually a high content of vegetable acid makes the reaction of the peat acid to chemical tests. Peat also continues rich microbial mixtures that may confer immunity to the user.
Peat baths are obtainable at any of the l3ritish spas, and it is unnecessary to visit foreign watering-places to enjoy their effects. They can be combined with any type of water and given at any temperature. Apart altogether from any medicinal value of the constituents of peat, these baths have two special properties in retention of heat, so that the bath remains practically constant in temperature, and in affording more support than plain water baths to weakened limbs; the latter property is of considerable value in the treatment of paralysed or stiffened limbs, where every effort has to be made by baths, massage and mechanical stimulation to restore function to the affected parts.
A further field of usefulness for these baths is found in the treatment of chronic skin diseases of an irritative nature; here the softness of the water has a powerful effect in allaying irritation and in promoting healing of the inflamed surface.
The method of applying the heat lamps is to sway it slowly backwards and forwards over the affected part. The distance between the skin of the patient and the lamp depends a great deal upon the toleration of the patient, and this toleration in its turn will vary with the severity of the pain which causes the patient to seek relief, and with other modifying conditions. The light in all cases must be applied directly to the skin and as close to the bare surface as the patient wlll endure.
In this the patient reclines on a latticed couch, and heat and light are supplied from eight lamps, each of which is controlled by a separate switch. The radiation of heat can thus be efficiently regulated according to the particular circumstances of the case.
The average duration of each treatment is twenty minutes. It is advantageous at the end of the first ten minutes to give an interval of one minute. At the end of the treatment the skin should show a w,ell-defind mottled erythema, which will persist for from two to three hours. Should the skin not be suddenlyy reddened, the treatment may be prolonged for five or ten miuntes more.
In cases of pain which can be relieved and held in check by one daily application until it disappears entirely, then daily applications are indicated. In some cases, however, the applications may have to be twice daily at the beginning but in others three weekly will sometimes suffice.
The cases of pain thax are more particularly benefited are rhemumatic and rheumatoid disease, sciatica and other form of neuritis, lumbgao and the varying conditions which are classed under the generic term fibrositis, and certain Functional discases of the digcstice system, espccially gastric irritability and pain.
In certain cases of heart discase diabetes or kidney trouble, radiant heat is of great value if cautionsly applied; in auto-infection of chronic dyspepsia or of constipation, in the toxaemias of those pcople who are being poisoned with the toxins of fatigue, either physical or mental, in the chronic toxaemia of rheumatism and in patients prone to gout or to headache due to some form of self-poisoning, possibly alcoholic, dry heat has a curative action.
Troughs, of which one centains hot water and the other water 70 to 80˚ F. cooler, are placed side by side, so that a limb can be put into each alterna!ely, 30 seconds in the hot and 15 in the cold. This benefits the local circulation.
Troughs, of which one centains hot water and the other water 70 to 80˚ F. cooler, are placed side by side, so that a limb can be put into each alterna!ely, 30 seconds in the hot and 15 in the cold. This benefits the local circulation.
By a sheet bath is meant the application of cold water to the body when enveloped in a sheet. The ordinary method is used for patients in bed and mainly in order to reduce the temperature, though it may also be used for its tonic effect. A waterproof sheet is placed on a bed and covered with a blanket, and a sheet wrung out of water at a temperature of 80 to 50˚ F.
The patient is placed naked on the sheet, towards one side of it, so that this side when brought over his body will reach the opposite armpit; it is also carried between the legs in order to separate them. The other side of the sheet is then carried overthe body, covering i n the shoulders, and is tucked in round the neck and legs. Water at a temperature of 50 to 60˚ F. is poured on from a cup and friction is carried out. The duration of the bath is from one or two to ten minutes, but it may be prolonged by turning the blanket and waterproof sheet over the patient thus making a cold pack (q.v.).
The bed is protected by a waterproof sheet covered by a blanket, and the sheet is applied as described in the text. The waterproof sheet should be arranged so that excess of water is drained into a tub placed by the side of the bed.
There arc two main varieties of shower bath: rain-bath; and needle-baths. The former consists in the application of a falling rain of water under gentle pressure from a height upon the body; the latter is supplied by means of fine forcible jets of water striking the body horizontally.
Added to the stimulant effect of heat and cold there is in these baths a factor of mechanical stimulation of the skin by the force of the impact of the water upon its surface. They are very useful promoters of vascular and nervous tone, and are extensively used to counteract the otherwise slackening and debilitating action of warm immersion and vapour baths.
Cold shower baths must be given with caution. Their first application should be confined to the limbs, and even in those who have become accustomed to their use it is well to protect the front of the chest from the first impact of the spray. It is well too to enconrage active movements of the limbs or to rub them briskly while in the spray.
The bed is protected by a waterproof sheet covered by a blanket, and the sheet is applied as described in the text. The waterproof sheet should be arranged so that excess of water is drained into a tub placed by the side of the bed.
For the application of heat or cold to the lower part of the trunk the sitz bath affords a convenient and useful piece of apparatus. It is used extensively in the treatment of inflammatory conditions of the bladder, perineum and anus, such as cystitis and prostatitis, with pain and scalding on passing urine, local irritation with or without excoriation of the skin, pruritus ani, and for bleeding piles. It is also a simple method of relief in many cases of painful menstruation and is sometimes of great help in the treatment of ulceration of the lower bowel (ulcerative colitis) with frequent and painful passage of mucus and blood.
The patient is seated in a bath of water at the desired temperature, to which antiseptics may be added if necessary; the upper part of his trunk is meanwhile protected from chill by warm coverings, and it is usual to place the feet in a second vessel containing hot water. It is important in the case of weakly or emaciated individuals to make sure that there is no pressure exerted by the edge of the bath upon the thighs; this can be prevented by placing several thicknesses of folded towel or blanket under the legs. It is sometimes necessary to place an air-ring under the buttocks to prevent pressure upon tender parts, and it is always necessary to provide a support for the back while in the bath.
The patient sits in a small bath, with a high and gradually sloping back. The upper body and the legs are covered with a blanket.
Most of the maladies which call for this treatment are best relieved by hot water, but in some cases short applications of cold are preferable, as in congestion of the external genital organs, and varicocele.
Exposure of the body to direct sunlight for carefully calculated periods of time increases the sense of well-being, for the rays of the sun have an active influence on metabolism, benefiting health and maintaining energy. Here are seen visitors to a sun-bathing clinic near Lonion.
Exposure of the skin to direct sunlight has certain health-giving properties but it must be carried out with due appreciation of the fact that such exposure may do actual harm and that some of the good effects attributcd to it have tended in the past to be over-rated. The rays of the sun's spectrum with which we are principally concerned in sun-bathing are the red or heat giving rays, and the shorter and invisible rays which appear in the spectrum beyond the violet rays and are therefore known as ultraviolet. The heat-giving wavcs dilate superficial blood vessels, stimulate sweat glands, warm and exhilarate the whole body.
It is obvious that this heating of the body can be carried to excess in the ahscnc of free perspiration, and in an atmophere saturated with moisture, so that the cooling effects of evaporation from the skin arc absent. Heat stroke may then easily result. In moderation the added heat of the body stimulates metabolism and is beneficial. The ultra-violet rays which affect the body are of very limeted extent aad are easily shut off by smoke in the atmospiure. They are most potent. at mid-day and in mid-summer: in early spring, winter and antumn they only reach the earth in an appreciable amount on clear days in the middle of the day when the sky is clear.
Exposure to ultra-violct rays produces, in time, pigmentation of the skin. This occurs more readily in dark than in fair people. The pigmentaton affords actual protection against an overdose of sunlight so that dark people are less apt to take harmful doses. Protection is also afforded by anointing the skin with oil, as this shuts out the rays that are potent for harm.
Exposure to the powerful ultra-violet rays should be very gradual, both in the amount of skin exposed and the period of exposure. Sun-bathing forms part of the curriculum of a modern school in the suburbs of Berlin.
It is essential that exposure should be gradual both in respect to the area of skin exposed and the length of exposure. It should stop short of reddening of the skin to any extent. In midsummer and especially on the mountain side and the seabeach there are a fair quantity of the health giving rays even on cloudy days. Injudicious sun-bathing causes discomfort or actual pain from injury to the skin, with restlessness, sleeplessness and a sense of fatigue. These effects must be carefully guarded against.
This procedure is easily administered even by untrained attendants, and is useful in cases of fever from any cause, in cases of persistent nervous excitability and sleeplessness, and in conditions of lowered vitality after serious illness.
The patient should be lying down, preferably on a firm narrow couch. His face and neck are first rapidly rubbed down with a loose towel that has ben dipped in cool water and partially wrung out. During the whole sitting it is usual to let a towel wrung out of cold water rest upon the forehead. The limbs are then quickly rubbed down in the same way, but for these and for the trunk water at a temperature of 75˚ F. is used on the first occasion, and gradually cooled at subsequent baths.
After the wet towelling of the limbs, the back and front of the chest and abdomen are treated in the same way, with the addition that the skin is briskly rubbed through the wet towels in order to overcome the depressing effect of the temperatnre changes and to promote tonic effects in the skin and muscles.
These baths may be repeated daily and they can be of considerable duration. Ill effects that must be watched for are chilling of the body, headache and restlessness instead of the desired calm and comfort.
This is a very powerful means of promoting skin action and the elimination of waste products, but its ritual entails proceedings somewhat exhausting, and render it unsuitable for those of weakened circulation and altered blood pressure.
It necessitates also the breathing of a heated atmosphere for several hours, and is therefore liable to do harm to those with a tendency to bronchitis and respiratory catarrh. Its main use in temporate climates is to remove the products of muscular fatigue and the accumulated effects of over-eating and deficient elimination of poisons generated by the bowel and retained by the kidneys. In cases of chronic renal inefficiency, Turkish baths may be of great advantage to the sufferer, but must be carefully supervised in all such cases and are actually dangerous in many.
Routine of the Bath
The individual enters the first hot room draped in a loin cloth. He may with advantage at this stage take a large drink of cold water. The room is heated by steam pipes or, proferably, by circulation of fresh heated air. The first effect of exposure to the atmosphere of this room is often a sensation of oppression and headache but these symptoms pass off after five or ten minutes with the commencement of sweating.
This sweating may be profuse, while the patient rests quietly for half an hour or more in the heated atmosphere. Robust bathers may then pass into the second hot room, which is kept at a temperature of 140 to 180˚ F. Many people find that they can only enter this room backwards; strong people can stand the intense heat for only a few minutes, and weaker people should not enter this chamber at all. In this hottest room profuse sweating occurs. Leaving the hot room the bather puts himself into the hands of a masseur, who lathers him all over with soap and hot water and massages his limbs and trunk with vigour paying special attention to any area affected with the stiffness of neuritis or fibrositis. After this massage the bather stands under a spray varying from tepid to cold, or takes a plunge through a tank of cold water; he then dries himself with brisk friction of a towel and lies down for half an hour or so in the cooling room.
It is of importance that his stay in thas room should be long enough for has skin to become completely dry and cool, and that when he leaves the bathing establashment he should wrap up warmly to avoid the risk of chilling the skin.
Benefits and Disadvantages
Turkish baths have a reputation for reducing weight. They certainly do so in many cases of obese individuals, but their effect is not lasting and in a few cases they lead to a definite gain in weight rather than a loss. In view of the intensity of the changes and activities that they induce in the functions of the body, they hould be used sparingly. They may produce great fall of blood pressure, and cases of fainting from this cause are not uncommon in the course of the bath.
Even in the case of robust persons two such baths per week should be regarded as a maximum. There can be no question of the value of the profuse sweating that they induce, and of the suppling of stiffened joints and muscles that they bring about, but they are a treatment for the comparatively healthy rather than for the invalid.
Several forms of apparatus have been devised with the object of surrounding the naked body with an atmosphere supersaturated with warm water vapour, but all have similar action, namely, dilatation of the superficial vessels, promotion of sweating, some raising of body temperature and elimination of poisons through the skin.
They differ in ths temperature at which they are employed and in the necessity for breathing of such heated atmospheres while the bath is in use; freedom from this unpleasant feature is a strong advantage offered by the cabinet type of bath over the chamber baths. These baths must be used with caution by the feeble and exhausted individual, and they are apt, if indulged in too frequently and unless subsequent stimulant measures are used, to produce a dangerous inertia of the skin and its vessels.
This consists of a bath of a suitable size to allow full immersion of any part or of the whole of the body, and is supplied with nozzles through which a forcible stream of water can be driven in a circular direction below the surface of the bath. The Water of the bath can be at any desired temperature, but usually the temperature of the whirling current is considerably hotter than that of the main bulk of fluid.
In the massage department at Guy's Hospital this immersion treatment is administered to infants whose limbs are wasted through disease or injury. The whirling stream is hotter than the rest of the water and is driven forcibly through nozzles.
These baths find their greatest field of usefulness in the treatment of stiffened joints and shortened tendons resulting from injury or disease; they are aids to the restoration of function in limbs paralysed by disease or accident to brain or nerve. Helped by the support of the water in which they are immersed, weakened limbs are able to carry out movements that would be impossible without such aid; at the same time the force of the driving stream of fluid massages tissues hardened by disease or disuse, and the constant temptrature changes exert a very stimulating influence upon the nerves and vessels of the skin.