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.
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.
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,
- the 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.
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.
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.
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.
 
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.
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.
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.
EYE BATH.
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.
EYE BATH: METHOD OF USE
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.
FOAM BATHS.
The 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.
FOAM BATHS TREATMENT
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.
MUD BATH.
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.
MUD BATH AS ADMINISTERED AT DAX
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.
MUSTARD BATH
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 BATHS.
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.
RADIANT HEAT BATH
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.
RADIANT HEAT BATH
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.
RAYNAUD'S DISEASE: CONTRAST BATHS
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.
RHEUMATISM: TREATMENT AT THE LONDON RED CROSS CLINIC BY BATHS, MASSAGE AND HYDRO-ELECTRICITY
Left, local application of ultra-violet radiation to a rheumatic joint and radiation of a larger area. Centre another form of total immersion bath with aeration. Right, use of the Schnee hydro-electric two-cell and four-cell baths and other electric treatment The baths are made of porcelain or some other non-conductive material, and are set upon a linoleum-covered platform.
SHEET BATH.
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.).
USE OF SHEET BATH FOR RECUMBENT PATIENT
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.
SHOWER BATH.
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.
 
SITZ BATH.
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.
SITZ BATH: SEDATIVE TREATMENT
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.
SUN-BATHING: PRACTITIONERS OF A NEW HEALTH-GIVING CULT.
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.
SUN-BATHING.
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.
SUN-BATHING BY GERMAN SCHOOLBOYS
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.
TOWEL BATH.
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.
TURKISH BATH.
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.
VAPOUR BATH.
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.
WHIRLPOOL BATH.
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.
WHIRLPOOL BATH TREATMENT
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.
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