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THE LIBRARY
OF
THE UNIVERSITY
OF CALIFORNIA
LOS ANGELES
GIFT OF
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TONIC.
It
vitality,
Ephraim Bateman,
" I
but in
have used
my own
it
Cedarville, N.
J.,
says:
individual case,
and consider
it
my
under
practice,
all
cir-
R.
I.
CAUTION: Be
t7i9
label.
MODERN
MEDICINE.
BY
SIMON BARUCH,
M. D.,
Attending Physician
VOLUME
GEORGE
S.
I.
DAVIS,
DETROIT, MICH.
Copyrighted by
GEORGE
S.
1892.
DAVIS.
Biomedieal
Ubnry
szo
1/:/
TO
DR WILHELM WINTERNITZ,
PROFESSOR OF HYDROTHERAPY IN THE VIENNA UNIVERSITY,
The Father
THIS
of
Modern Hydrotherapy,
WORK
DEDICATED
IS
BY THE AUTHOR,
as a token of appreciation of
tion received
in
by him
at the Institute
Kaltenleutgeben.
Rofi/nc;
TABLE OF CONTENTS.
PREFACE.
Page.
English Language
Author's Indebtedness to Prof. Winternitz Hydrotherapy Severed from Hydropathy Water to be
Used as Any Other Remedial Agent, Not to be En-
No Other
Original
Work
the
in
xiii-xv
Basis
CHAPTER
I.
Definition of Hydrotherapy
History
of
Currie, Joseph
Franck, Hufiand, Priessnitz, and the Empirics--Op-
Academy Overcome by
Demonstration Bouilland
Clinical
Convinced Scontetten,
Lubanski, Fleury, Duval, Charcot Modern Fever
Treatment Ernst Brand Testimony of Niemeyer,
Dujardin-Beaumetz, Peter, Erb of Heidelberg, Semmola of Naples, Hoffman of Leipzig, Hiram Corson
of Pennsylvania
History Repeats Itself The Best
Men Advocate Water in All Epochs Therapeutic
Nihilism of the Moderns Water Again Triumphant
X.
under
Page.
Juergenssen, and Ziemssen AntiMisleads Chemical Antipyretics Abused;
Brand,
pyresis
Water Suffers
New Dangers
in
Naturarzte Father
for
CHAPTER
II.
Internal Use
tions of
Agent
for
Graphic Demonstrations on
Effects
Schiiller's
Trephined Rabbits
XI.
Page.
Matter Increase of COg and O Interchange Practical Deductions
Influence of Thermic Applications
upon the Body Temperature Local Temperature
Depends on Arterial Blood Supply Peripheral Circulation the Chief Element in Heat Regulation
Compensatory Action Fallacies Exposed Difference between Mouth and Rectal Temperature After
Cold Baths Reaction Aimed At Laws of Fleury
and Winternitz Practical Deductions SummaryMechanical Irritation a Valuable Aid to Baths
Rationale of Cooling
Experiments in Zunz Laboratory Temperature Changes Depend Chiefly on Heat
Dissipation
"
III.
Necessity of Precision
Do
It
"
Emetic Enema
Drinking Hot Water Irrigation in Gastric and Intestinal Disturbances of Infants
Lavage for Diagnosis and Treatment Technique Detailed
Illustrations Gastric Irrigation for Treatment
Lavage
and External Hydrotherapy Combined Lavage
Dilatation of Stomach Gastralgia Intestinal Obstruction Colic from Gall Stones Catarrhal Jaundice
Dysentery Lead Colic Water in Gynaecology
Dr. Emmet's Practice, Illustrating Importance of
Details Water in Surgery Old and New Wound
Treatments Compared Hot Water as an Antiseptic;
Influence of Water in Cavities
PREFACE.
That the proper methods
observation.
abandon it.
As Ziemssen has justly said, " whatever we know of
hydrotherapy, we owe to Winternitz."
To Prof. Winternitz
I am personally indebted, not only for knowledge derived
from his numerous scientific and clinical writings, each one
to be inclined to
of
which
is
in
Kaltenleutgeben,
where the
best
informed
method
it
will
of
hydropathy
of treatment
or
the
water-cure
system,
that
that
XIV.
its methods are simple
It is the author's purpose to
comprehended.
sever hydrotherapy frotn any connection with hydropathy or watercure, and so present the subject that the general practitioner
its efficacy is
and
easily
may
learning
much
less.
The author
while he recognizes the undoubted value of water as a therapeutic agent, he is not prepared to substitute it for all other
therapeutic agents.
He would
result of clinical
were he
to
own
disregard the
the marvelous.
Drugs
which possess the power of reducing or increasing the rate
of the pulse, of diminishing or enhancing its tension, of
lowering at will the temperature when elevated by disease,
of lulling to rest the wearied brain, of completely abolishing
local or general sensation, one or both, of supplying deficient
elements in gastric juices, neutralizing peccant matter in the
gastro-intestinal tract, etc.
such drugs are entitled to the
respectful and careful attention of the conscientious physician.
Of all men the physician should be broad and liberal,
and should shrink from all exclusive or universal remedies.
For this reason I beg to emphasize my belief in all those
drugs whose effects have been positively demonstrated in the
laboratory and at the bedside, while I espouse water as perhaps the most potent of all remedial measures, upon the
historical, physiological, and clinical grounds succinctly set
forth in the following pages.
Herein lies the distinction be-
XV.
inasmuch as
it
effect.
It
is
in
CHAPTER
I.
HISTORY.
of the
its
combination with
The modern
applica-
utilized
in the
treatment of
disease.
The
surgical
use of hot water for purposes of asepsis, the gynaecological application for the treatment of pelvic inflamIts internal use in gastric derangements, the
need of tepid temperature in intestinal diseases, all
these belong to the field of hydrotherapeutics, because
they depend upon the effect of temperature and
mechanical results of water alone.
mation,
The
in
cardiac
and
(frozen water)
inflammatory affections
furnishes
The
belongs
to
the
same
category.
The
ternal
tice of
and
is
the prac-
more
fruitful
water
in
field,
some shape
whose limitations
is
shall
be that
ment.
DIVISION OF
THE SUBJECT.
It is
hydrotherapy to the reader's attention upon argument derived from historical, physiological, and clinical data;
in
it
precisely as
all
HISTORY.
It
sions
their
is
profes-
tion, the
to
of
It
field
the world,
alone pre-
error.
is
it
propositions
peutics treat
it
they dismiss
it
in
a few beggarly
lines,
preferring to
and whose
at least, problematical.
The
is,
in
most instances
remedy has
so creditably passed
at
a time
when
the
Prusa.
Sulla.
became
self
the
bosom
friend of Cicero,
and won
for him-
reputation
It
was
Hence he
his chief
aim to cure
cito^
cautiously,
from the disrespect with which it was rethe Emperor Augustus owed restor-
To him
garded.
Suetonius
tells
the
privileges
of
besides
Horace,
too,
was
patient.
his
His
Musa pronounces
water even
book,
"Antonius
makes me obnoxious
in cold
first
to the place,
in the
when
midst of
am
bathed
by
his pre-
Roman
(called
frost,
scription."
Cornelius
Latinorum
bosom
Celsus,
the
learned
Hippocrates,
friend of
all
6
edge suffered from the ignorance, witchcraft, and
fraud arising from the barbarism of migratory peoples,
from the destruction of the Alexandrian library and
school, from the demolition of the Roman Empire,
the plundering of Saracens, and the conquest of
At this time
Spain, science and art lay prostrate.
appeared Alexander of Tralles and Paulus .-Egineta.
The former refused to rely upon any system of medibut insisted, with a true philosophical spirit
cine,
which would do credit to him to-day, that the physician must depend in each single case upon the age,
constitution, natural powers, and mode of life of the
patient, as well as
tions
and
effects of nature.
for bathing
and rubbing
in
He
many
is
furnished directionsdiseases.
and he
it
was who
first
figure in the
history of hydro-
famous professor
baths
No
is
in fevers,
of Ferrara.
He recommended
Julien (Comptes
physician,
is
written.
Hoa
rheumatism
used hydro-
The
Hoa
historian
ordered one
hundred
came through
all
the
seventeenth
century
Herman van
der
forty years
He
later.
many
converts at
names
home
of great
value of such
names
He
illustrious physician of
Europe
at that
many
followers.
commanding
The first dis-
upon the
to
first
He improved
bath, and
exanthemata.
Hence
the
first
the
produced
later
may be
credited
in
Moscow
in
in
fact
translated
in
into
work was
hydrotherapy.
Currie's
several
foreign
Vienna hospitals by
His application of water was not
limited to fevers. In gout and convulsions, paralysis,
tetanus, and other diseases he claims to have obtained
good results. To mention Hufeland, the enthusiastic and yet judicious advocate of hydrotherapy, is to
give the imprint of true medical wisdom to it, and to
indicate its wide adoption among the profession. He
practice was introduced into the
Joseph Franck.
offered a prize
the action of
metrical
become popular
until the
lion's.
treatment,
many
of
still in
use.
copious literature
sprang up in all parts of the world, and many institutions were modeled after his.
The Government built
roads to facilitate access to his establishment; monuments and fountains were erected to his memory.
Physicians from all countries, who had been attracted
to the Silesian peasant's mountain home, became converts to
An
therapy
and missionaries of
his practice.
Doctors
Engel and Wertheim petitioned the French Governfor permission to open a hydropathic institution.
The petition was referred to the French Academy of
Medicine, which appointed a committee consisting of
The last named deBouilland, Velpeau, and Roche.
livered such a tirade against hydrotherapy, characterizing it as dangerous, unscientific, chimerical, and opposed to the simplest laws of physiology and pathology,,
that the sixty members present made an adverse report
amid great applause. Ou this report the Minister of
ment
Instruction refused to grant permission for the erection of hydropathic establishments to Engel and
Wertheim. These physicians appealed from the decision of the Academy, and requested the authorities
This
to investigate hydrotherapy in the hospitals.
popular attention,
etc.
" It
lies
in
the interest of
The
great
physiological demonstrations.
in-
by physiological and
rational de-
ductions.
Modern
its
great initia-
when great clinical teachers reaffirm their faith in a method of treatment which had
received the highest encomiums from Hippocrates,,
to the present day,
Niemeyer,
in his
book on
practice, says
of
it
in
scrofula:
in the
"The
benefits
we
obtain
its
physiological effect
system,
lowering influence."
Prof.
M.
his preface
in
to
work on
Bailliere,
says:
"
?"
he asks.
In
his
classical
contribution to V. Ziemssen's
"
To
in
belong
cyclopaedia, Prof.
most
the
termed
'
varied
(nervous diseases)
forms;
that
cent times
more
viz.,
practiced
exactly,
it
more
is
rationally
usually
in
re-
and studied
and
which
Having been
heightened
the
13
produce an equally poiverful effect upon the nervous sysThe italics are mine.
tem."
Semmola, Professor of Therapeutics in the Naples
University, whose lectures (1890) have been transGerman and have received a laudatory pre-
lated into
from Prof.
face
Unfortunately, these
without
strict
each case, etc. Without going here into the mechanism by which a rational and earnestly practiced
hydrotherapy may lead to a rapid and truly organic
renovation, provided that the apparatus of the econis capable of responding to the increased labor
omy
thrown upon
it,
one thing
is
by physiological
by measures which act in accord with
agencies,
/.
e.,
normal functions.
"//
fiot
place
is
to be
treatment which
it
14
deserves, for,
is
made
"
of
it
in diathetic affections.
in
remember
common term
of retardation of tissue-metamor-
and
therefore certain
local
oma,
and imfailing
effects,
unless the
In these cases,
also powerless in
its
in
is
results."
Prof. F. A.
his
recent
lies
the unsur-
15
for
we
in therapeutics;
it
the heart
invig-
the capacity
itself.
Ex-
really
things.
What we have
we may apply
Cold water
we may most
exercise
in I
of
all
We shall have
say of them, and see that they are much
On page
much
to
and
of their effect
activity of the
upon the
falls
ground."
On page 385 he sums up as follows: " If we review briefly the bath treatment, we find very great
uniformity in its effects; almost everywhere do we see
the treatment of gout, rheumatism, scrofula, chronic
infarctions and exudations brought forward as indications.
" If
we add
ated nearly
all
we have enumer-
upon the heart, lungs, liver, stomach, intesand kidneys are rarely thought of. / believe that
a great gap exists here.
Effects
tines,
"We
i6
correctly
become convinced
estimating
Nevertheless
diseases
of
of the great
their
effect
with
difficulty of
precision.
The
drawn
italics
of
are mine.
The
cal
Magazine (Nov.,
1891)
letter:
Professor H. C. Wood:
and
all
other "
itis "
it.
it
is
remedy equals
it.
Think
Moder-
one
17
often
cate
Farewell.
it.
As
ever,
your friend,
Hiram Corson.
Maple
I
But
Hill,
i6th, 1891.
special
hydrotherapeutists, but
medicine
France
Au^st
men,
too,
presentatives of
who
good
The
are teachers of
are
known everywhere
as re-
clinical teaching.
who
in the best
itself
opinions
of
here as
the
in
other de-
most judicious,
lightened era.
therapy
many
The
cycles in
the
it
estimation of physicians.
must be brought
The
out, in
promise of a rational appreciation of water as a remedy, which, however, was overshadowed by the ten-
Just as
therapeutics.
iS
among
the
ancients
we
find
renowned physicians the most active advocates of water as a remedy, so does its history in modThe simphcity of
ern times develop the same fact.
this remedy, however, antagonized the pedantic and
self-important members of the profession; and when
laymen, who must have learned its value from observing its effects in the hands of physicians, espoused it,
Thus did it
the latter became entirely estranged.
come about that Priessnitz created a sect, the Hydropaths, whose influence for the popularization of the
treatment was in inverse ratio to its adoption by the
the most
And
profession.
espousal of water as a
remedy
is
Are we
adoption.
entrust
their
lives
and health
Due
into
our keeping
reflection
its
who
in
must bring
is
to physicians
who
lived
by
Coelius
* Lucas;
Aurelianus.*
An Essay
long before
his time.
The
was originated
And nearly one hundred
for instance,
on Water.
London,
1756.
19
scarlatina,
and measles.
The broad
Catholicism which characterizes modern medicine had liberated hydrotherapy from the
absurd stigma of its empirical relationship. The violent methods of treatment prevalent in the first five
decennia of this century were gradually usurped by
more rational methods. When, in fact, a therapeutic
nihilism threatened to take their place, water again
came
remedial agent,
Brand,
in
acute diseases at
The
least.
their
Again,
followers,
to the attention of
tests at
the
bedside.
20
am
an enemy to
Berlin professor to
educated
me
last
Although
who was
was
warm
Thus has
an
hydrotherapy
in
many, while
chronic disease
antipyretic."
is
"
year.
in
advocate of bathing,
therapy.
all
in
acute
come about
it
disease
is
abandoned
increases
it
its
it
that
by
hold on
effort
to
clinical teachers
prevent water
threatens hydrotherapy.
combined
medicine
with
The
excessive
blood-letting,
which
medication,
characterized
century and
in the
Europe, developed the expectant method of treatment, which aided the system
in
its
battle
against
the former.
from
21
"the
cinal agents,
proved
to
as salicylic acid,
produce
antipyrin,
etc.,
were
is
is
considered.
the flanks
up some of these
servative
The
?)
ideas.
result
is
the
field.
Men
like
by
nihilistic
who propagate
lectures, books,
in driving
and periodi-
more
or less intelli-
gent
(con-
the formation of a
women
of
and cold,
vapor, and hot-air baths, exercise, massage, and diet,
.a system of Natur-heilkunde, which must very soon
bring reproach upon hydrotherapy.
The latter is
their chief reliance; these men, being uneducated,
-apply it empirically, and propagate their errors among
the people.
There is a large institute at Chemnitz,
in Saxony, devoted to the treatment of natural remall
edies,
which
have
visited,
German Govern-
Whether they
shall be allowed to
remains to be decided.
Thus far I know only one such hydrotherapeutic institute in New York, in which the treatment is most
educated quacks.
here
by and allow again the value of water as a remedial means to be overshadowed by the efforts of
these unskilled advocates.
If they can obtain good
therapeutic results, which I do not doubt, how much
more may a correct and rational application of the
remedy accomplish.
idly
CHAPTER
II.
mode
it is
of action as far as
So
now
subjected to
tests
Fortunately,
we
other than
merely clinical,
have come into practical use.
body
its
reader
will
be asked to accept
applications in disease.
The
complex
effect of water
in
its
is
appli-
cations.
The
is
is
distinct in effect
from
The importance
24
only in order to
it is
emphasize the
in
all tissues, is
referred to here
effect
these by
changes
of
its
increased
imbibition.
are observed
when water
is
applied externally,
is
the following
sphygmographic tracings:
Before drinking
^A,
quart water at 43 F.
25
These tracings
after
may be compared to the following, taken beand after drinking 0.3 litres of water of about
tracings
fore
90 F.
The change
That
reversed.
in
this effect
is
is
precisely
it is
must be the
It
Excita-
Warm
26
may produce
fluid
The
Water
tem.
is
means
low state of vascular tension; impoverishby diarrhoea, haemorrhages, profuse perspiration, and even copious urinary excretions;
a feeble percentage of salts in the water; the presence
ditions.
ment
of the blood
of free alkali in
it; all
of water.
It
of
Bocker
and
others
that
at
the
administration
intervals of
of
20 to 30
the tissues, render the blood column heavier, and increase vascular tension and pressure.
effect
may be produced,
exudations,
etc.,
/.
^.,
The
contrary
absorption of watery
tions.
and productive)
is
enhanced.
27
"
There
is
no
after
tion,
In the institutions
rule, so
it is
gins
more
the
rejuvenation
energetically.
the
of
therapeutically considered."
especially as
monstrated
whom
by
it
entitled to re-
are Hosier,
diuretic,
urine,
is
especially urea.
Thus
constituents of the
it
is
evident that a
more
active
change
28
of nitrogenous material
As
it
inaugu-
is
shown
is
is
utilization
simply the
effect of a
vessels
Be
by
this as
increase of
Water
that
is
drunk
is
it,
some
especi-
the glands.
The latter are forced to secrete
more abundantly, and the heart is called upon to
ally
propel
skin are
larger quantity of
stimulated
to
fluid;
increased activity.
And
all
is
29
Peristalsis
water.
This
persons and
is
by imbibition of cold
increased
may be
in
is
introduced by Krull
upon physiological
We may
in catarrhal
jaundice established
principles.
many
ex-
periments, whose details space does not admit of recounting, that, inasmuch as an increased absorption
of water into the veins
more work
to do,
we have
the administration of
in
is
it
is
clinically
if
the rationale of
remembered
is
felt
its
of.
much upon
reflex
by
when
nerve
applied in
30
metz, Debove, and Sahli, as will be shown in the clinical part of this
work.
Suffice
it
lines,
who promotes
diuresis
the poison.
method
of hydrotherapy, as in
bring
its
much
to
It
must be
evi-
its
excessive use
must overburden the system, and, if the latter be already enfeebled, must tend to cripple the organs it is
intended to relieve.
importance.
mode
thorough study of
when applied
to the periphery
of applicaits
physio-
is
of great
31
effects,
such as the
antiseptic
is
That
may be
gramme
130.
32
may be
varied
same time or
to the
to its
effects
body at the
immense value as
in
By means
we propose now
to do.
of low
produce positive
temperatures we
may
neutralize
irritation
already
existing; thus
ing effects,
agents.
As Kroeger has
ceives
certain
sions of light,
aptly put
it,
and
telligible
observed
all
in
cold.
in-
are
upon
the organism.
EFFECTS OF TEMPERATURES.
peuticst
S3
to contract
certain limits.
it
evident
how
powerfully
we may
upon muscular
indirectly
is
activity,
and
interwoven with
by these means
all
Although it is
from the mechanical
difficult
effect,
separately as far as
may
it
it
will
be regarded as nerve
admit.
irritants
in proportion to the difference of temperature between the part receiving the impression and the agent
conveying it.
There is, however, a limit to the therapeutic
application of thermic agents.
Both extremes of
temperature become painful and, as is well known,
may destroy sensibility and eventually vitality also.
Recent investigations by Donath (Archiv. fur
Psychiatric, 1884, xv) have placed the painful cold
In different
between 29 and 73
F.
Painful
heat
impressions
between
EEE
34
special
terminal nerves
the
in
skin,
and
diffused.
that of heat
Warming and
is
more
deliberate
Thermic
irritants
tracts, in the
nerve centres,
trophic fibres
fall
The
effect
upon motor
fibres
numerous
independently of
the
higher
nerve
centres.
35
would prove
rstrates
it
The
this.
in the
But
clinical
experience
demon-
the
revivification of a
fainting
faction.
intent, in
in
arousing flagging
vitality.
That extreme heat and cold may destroy sensaeven to complete death of the part, is an undisputed fact. But it is not so generally known that
cold applied to a nerve trunk may produce
anaesthesia,
and even paresis of its peripheral fibres.
tion,
Waller applied
ficial
nerve
in its
and obtained
anaesthesia
superat first
of
its
36
Mitchell for some valuable investigations upon theHe demonstrated (quoted by Winternitz)
subject.
may be produced by
intense
if
in,
blood-vessels.
its
for
some cases
of acute-
Upon one
point
all
its
duration,
viz.,
in
is
viz.,
proportion
This
is
of
immense importance
in clinical
hydro-
it
is
applied; the
more calm
sudden and gradual
latter
is
37
spheres,
i.e.^
That the
may produce
effect
of
be far-reaching
.INFLUENCE OF
The impact
the skin, as
is
is
tem-
may
THERMIC
APPLICATIONS
CIRCULATION.
of cold
matter of
UPON
THE
common
to
observation, induces
The
is
of
corpuscles
blood
becomes
diminished,
when
the
part
pale.
a
and
arteries the slowing of the circulation is followed by
brief and rapid oscillations, which become slower and
more infrequent. Slowly the vessels become more
pale, less transparent, and, finally, the movements
cease, until the vessel is blocked and occluded.
When the cold is less intense and more proQuickly
following this
acceleration there
is
the application
is
it
which now
If,
however,
and blocked. A collateral hyperaemia in neighboring parts is the result, which producesmore rapid circulation in them.
It is not difficult to deduce the most important
physiological changes as the result of this energetic
influence of cold upon the vessels, as will appear
also contracted
farther on.
The
vessels
is
is
commonly
supposed,,
When
the
together with
strikes the part, the
39
dilatation
following the
latter
true of
all
This
of cold.
REACTION.
is
of the
the immediate effect of the application of
This
is,
congestion, and
The
circulation.
superficial
impact dilate most quickly after the primary contraction has passed.
They become distended with blood,
but, since the continued application of cold renders
the capillary circulation sluggish in the parts subjected to it, the veins respond less actively to the excitant
influence of cold, and, their contraction being more
slow, their dilatation
is
Thus
correspondingly slow.
contraction would, as
well
ence
all
known, materially
happens, or
sels,
is
if
cold
is
influ-
If
this
accommodate themselves
The
to
result
40
in
pates
The
if
is
is
irritants
ened tension
in
It
is
scarcely
that
The
effect of
is
ferred to above.
Thus
powerful effects
sels.
An
the periphery
not directly
in
is
obtained
in
their effect
upon parts
41
changes,
is
accom-
plished.
If the
sels,
As
it
blood
is
a result
we have
collateral
hyperaemia, accom-
pathological
conditions,
accumulated
within
may be removed.
This
brief
explanation
hydriatic procedures
and
of
the
possibilities
of
real cure
by endowing
all
42
Like
ever, this
elderly people,
and
in those less
mature
also,
to the
is
called
into
action.
The experienced
if
43
active
of
filling
the
arterial
system;
hence,
action
is
it.
is
not
is
graphic tracings.
cold
vessel
enhances, while
walls,
dilatation
of
the
surface
vessels.
In the
former,
however, we have an accelerated and increased passage of blood, with the vessels under high tension;
while in the latter we have the vessels under low ten-
sion,
44
must sooner or
evident; hence,
it
is
later
produce a hyperaemia
is
differences
physiological
dilated,
elasticity.
PRACTICAL DEDUCTIONS.
The
this subject
Sammlung,
If,
p.
then,
is
clear, that,
259.
we may by varying
applications of heat
and
disease,
and which
of urinary flow,
which
is
in
typhoid fever,
is
45
Not alone,
of blood pressure after cold application.
however, by direct vascular effect upon the continuity
of the vessels
may
be produced.
this influence
Formerly
this
hyperemia.
accumulation of blood on the surface after bHsters
or rubefacients withdrew blood whose fluxion to in>
ternal organs was pathological, and thus proved anti-
local external
This fallacy was exposed by the investigations of Naumann, which have become classical.
phlogistic.
REFLEX EFFECTS.
Naumann
of peripheral irritants
He
while he ob-
irritant.
more severe
46
stasis occurred, as
The
effect of
there was
feeble
irritant
strengthened
it.
As
entirely reflex.
same manner
is
as other irritants.
precisely in the
Naumann
continued
investigations
conclusions as follows:
1.
The
action of epispastics
duced by means
is
essentially pro-
organ.
2.
These agents exert considerable
upon the activity of the heart and vessels.
3.
influence
vessels
circulation.
5.
47
in
body by long-
the
last
a considerable
longer they
often
still
the stimulation.
6.
The
maximum
attains
its
The
weak cu-
much
later
it
it
finally
is
this
appears
after
more
As a consequence
of
a stronger cutaneous
mostly after a
down
hour
its
conclu-
48
Max
Schiiller's
experiments also
may be
made
alto-
without
49
became
temperature
mated
in effect to that
tion.
The
produced by
which approxi-
local ice
applica-
Immersion
in
elevated.
Immersion
similar to
produced
and duration.
Under
warm douche
effects
Cold
the
rec-
KEE
0^
firmed on the
the rabbit.
was enabled
to
He
ascertained that
the vaso-motors.
the blood
is
in
the
driven
PRACTICAL DEDUCTIONS.
These valuable deductions enable us to reason
upon the various and somewhat paradoxical effects of
cold and hot applications Upon the heart, as the
chief agent in the circulation, thermic applications act
it
at the
periphery.
The
first
is
sensory
51
manifested by the
is
lowed by an increase
is
fol-
of vascular tension.
rate,
rest follows
it,
becomes
less
rapid;
if
Even
open
air,
and
in
Kaltenleutgeben,
ment
upon the
more manifest.
circulation will be
patients out in
the
when
at its height,
immediately after
is
rising,
It is a well
companied by an increased
The
is
always ac-
in the
it.
organ being
52
Although much additional proof could be furwe have dwelt upon the manner in which the
influence of thermic application is exercised upon thenished,
it.
Having shown
may
it is
clearly
how thermic
and the
applications
circulation^
Common
proposition.
The deepened
respiration indicated
by
sensitive part,
is
patent illustration of
may be
exerted,
as in a fainting person.
moment
The
patient
thing occurs
in
health
53
is
too cold.
When
is
Warm
applications,
approximating
the
number of respirations.
them more shallow and
frequent.
the
renders
hot
air
become
is
panting.
periment that
of
COg and
tainly
in the
only reliable
enhanced by
cold,
the excretion
is
cer-
The
test,
is
approximately constant.
normal
is
at
The seemingly
produces the reverse effect.
paradoxical effects of thermic applications are thus
tur
explained:
upon
tissue
54
Pfliiger
regarded as axiomatic.
resulting as a reflex
is
chiefly
consumption of albumen.
The
manifested
no increased
metamorphosis
is
tissue
similar to that
Heat abstrac-
tion, as
55
Juergen-
in six to
it
tion.
of
the assertion
absorption and
perature
is
absorption
excretion.
is
respiratory function, as
PRACTICAL DEDUCTIONS.
Winternitz justly
cites,
among
upon
tissue change,
flesh,
ment
56
whose age (over fifty) would render the weight someThose hydriatic procedures which
what stable.
stimulate diaphoresis are especially calculated to aid
tissue
in the blood.
Pro-
and
salts.
Inasmuch
as there
is
means involves a
UPON
THE
Without entering upon the physiology of heatproduction and elimination, many of whose points are
still
sub Judice,
we propose
temperature of the
57
show
to
how
clearly
must
suffice for
work
the
surely be
it
This
is
the
aim of this
the
to
human economy.
One physiological
above
that the
blood returning from an organ in a high state of functional activity is warmer than the arterial blood passing into
it,
is
ment
in the
all
is
an important
ele-
Add
the physiological
depends
is
equalized
It re-
mains now to demonstrate how, by utiUzing this powerful influence, we may reduce or elevate the temper-
_
ature in the
58
human economy.
is
has been recognized since the primitive days of mediIndeed, the idea that the reduction
cal investigation.
of temperature
is
the chief,
if
of the baths has so strongly rooted itself in the professional mind that it is difficult to dislodge it to-day,
when we have come to realize that this is only one of
its
valuable manifestations.
There
is
heat-producing centres.
There
is
is
traceable to the
abundant evidence,
is
directly ex-
known
in this
direction
is
twofold.
ferent temperatures,
once make an
peratures.
by coming
It
The mode
is
a well
two bodies of
dif-
in contact, will
at
tem-
however, and
is
is
endowed with
compensatory powers which enable it to resist dangerous encroachments from external temperature agencies.
COMPENSATORY ACTION.
The
compensatory powers
ature of the
~
face
The temperature
may be reduced
59
or elevated by
body
sur-
contact with
its
inner parts
the
occurs,
are
protected
against
dead
with
On
part.
effect falls
it
is enhanced
muscular structure, endowing the parts invaded
with more vitality; because the muscular tissue is a
bad conductor; and because the tonic contractions of
the muscle which ensue upon the application of cold,
for instance,
create
more
heat.
Thus
the external
re-
FALLACIES EXPOSED.
The sooner
this
important point
thoroughly
is
For the
fal-
is
still
so
so
commonly accepted
as correct
ciated.
6o
is
after
fact, I
elsewhere also,
must
in
upon
insist
its
it
here,
as I shall
antithermic effect
in
is
may
its
The
be removed.
fact
shown by Liqbermeister (Handbuch der Pathologie und Therapie des Fiebers, page 102), that, dur-
is,
as
does not
limits,
fall,
the
if
its
inner temperature
The second
of
the
We know
circulation.
body
the
little.
lies
in
cutaneous
when
is
is
when cutaneous
surfaces
traceable
to
This
effect
is
applied,
6i
of blood
when
cold
is
it
in
an opposite
much
in France
toward explaining hydriatic procedures upon physiological principles, offers the following results deduced
from careful experiment: Dipping the body into moderately cool water (48 to 58 F.) for thirty minutes
reduced the temperature of the surface, while the
inner temperature did not change at all.
The more
brief the application, the colder it was made, and the
higher the surrounding temperature, the more rapid
and complete is the reaction. The reaction entailing
the re-establishment, and even the increase, of the previous temperature depends upon the conduct of the
patient after the applications, it being more rapid and
complete under active and passive exercise of the
parts, especially a warmer surrounding medium.
Another important deduction made by Fleury is
the fact that reaction depends upon the individuality
of the patient and conditions of the circulation and
These simple facts have
innervation at the time.
again and again been verified by numerous authentic
direction.
Fleury,
authorities,
and may,
if
correct understanding of
hydrotherapy.
so
in
62
WINTERNITZ'S LAW.
They confirm
amount
of temperature reduction
depends more upon the intensity of the thermic irritation of the cutaneous sensory nerves than upon any
other element.
drunken man
one in a less depressed condition of the nervous system may present
a ruddy, healthful glow from the same exposure, is
may have
fact that a
last of
Fleury's laws.
PRACTICAL DEDUCTIONS.
In typhoid and other infectious fevers
it is
^'mport-
ant to bear this law in mind, for the same bath which
may
may
in the third,
when
his
nervous system
is
first
w.eek
depreciat-
all
functions de-
work
well
is
written; but
it is
its
-63may
as
we can determine
positively,
it
derived, so far
is
This
is
circulation
referred
as
in
the general
above,
to
follows
face, friction
is
resorted
more
to,
is
intense.
SUMMARY.
Winternitz sums
up
the
automatically acting
The
may be
temperature.
injurious rise of
the change
in
body temperature
heat
production:
are, aside
Increase of
from
heat
to the enlarged
64
heat
There
is
tion
less
medium
equalization
There
less heat
cooled
heat
of
off there.
proportion to
The
the
medium
in
contact with
it
The
body takes
place, aside
ration, ingesta,
direct
heat
from the
cooling of the
conduction through
in
proportion to the
the
single
tissue
layers, each of
conduction.
stream
is
interrupted in
it."
65
when
forced through
its
it.
The
is
creased.
it
temperature
by actual
is
in-
Winternitz to have
to the credit of
is irri-
It is
demonstrated
first
surface
medium
in
vessels dilate
mathematical
calcu-
His
by actual demonstration in
of
these
propositions.
fifty
tions
1.
up
The
Mechanical
irritants
may produce an
increase
Weaker chemical
irritants
produce an increase
cutis an-
up to 80 per
8.
5
cent.
rest,
produce,
66
an
in-
Cold rain-baths,
9.
with
subsequent exercise,
Warm
10.
subsequent
rest,
rain-baths,
11.
we accept
may
may be
explanation
why
we have
a ready
may be
in
fevers
will
be
The
for heat
maintenance enables us
to influence temperature.
To
cutaneous agency
in disease
powerfully
of having
first
demonstrated how active
mechanical action on the skin, combined with the application of cold water, enhances the temperature-re-
credit
ducing
effect.
other
He
67
stimulation
active
friction, or
and
may be made
etc.,
to dilate quickly
off the
coming from
many
now
is
inconsistencies.
It
cooler
explains
The
created.
exchanged
is
within.
in
is
method
created, which
now
is
clear that
amount of compensatory heat increase is not dependent upon the absolute amount of heat abstraction, but upon the intensity of the thermic nerve
irritation, and the degree of actual cooling of the
the
peripheral terminal nerve fibres, which govern by reflex action the increase of heat production.
if
in
This
will
same temperature
of the
in the other
he
is
In the
lies
quiet
subjected to
first
instance
layers
not
is
is
much
tion
down
is
less,
its
related vessels
^
is
6S
diminished,
is
is
prevented, and^
Winternitz
tions, in
of cool-
human body
that the
impediment
body temperature
result of cold as
first
and
its
an
irritant
vessels,
in
which produces an
latter is com-
more
intense.
more or
the former
it
Changes
will
in
is
The
to heat-dissipation.
pensated completely
man
in
induces con-
latter is
After
less;
in
remain constant.
heat-production
may be added
to
by
or involuntary, which
other irritants.
in
man
may be
far
fall
Hence
of temperature.
it
chiefly
cent investigations, of the view he has long promulgated, and he concludes his magnificent chapter on
this subject as follows:
" If you connect the above with what happens in
thermic and mechanical procedures, with regard to
the blood and heat distribution, the control of heat
dissipation
or
rather, as I
may
in
the
first
is
you
will find
it
all
fever processes
remedy,
if
especially, because
properly applied,
is
no other
this
We
have now, as
briefly as the
importance of the
70
upon those functions of the body upon which its inAn agent of
depends in health and disease.
such power must be capable of utilization in therapeutics as no other known agent can be shown to be.
tegrity
CHAPTER
III.
is
NECESSITY OF PRECISION.
The
cedures
first
is
element of success
in all
hydriatic pro-
The absolute
method, duration, temperature, etc.
necessity of an exact technique in the application of
water as a remedial measure is unfortunately not appreciated by the profession, and its neglect is undoubtedly a cause of the failures which have operated
in preventing the more general adoption of hydrotherapeutics by the practitioner.
so readily obtainable,
and so
Water
is
so simple,
easily applied
that
it
72
etc.,
and
difference
the
Charybdis
over-activity,
of
It
in-
to
mon
com-
The
first
mystery
in
is
is
tion
water,
of
though
it
the appreciation
no sleight-of-hand or
the hydrotherapeutic methods, there does
be.
simple
few
and
in the applica-
universally
illustrations
applicable
from our
clinical
ILLUSTRATIONS.
73
was
The
latter
sity
for
is
some
made
is
fulfilled
precision
is
well understood, however, by
our metropolitan hospital physicians was
evident to the .writer by the receipt of a written
of
him
in
instructing his
Another
illustration
may be
of service.
The
two cases
of
summer
diarrhoea of infants.
inefficient
in
Finding
these cases,
inquiry elicited the fact that in one case the attendant (who
the upper into a drainage tube by cutting three eyeholes into it.
Is it surprising that the introduction of
with the
irrigation
through
it
74
case
to,
of the case.
In the other
this neglect of
picture
letter
is
received
New York
" I
of
contained
in the
by the
The
reverse of this
writer.
City, says:
summer
diarrhoea in a child, 18
months
old,
by
down by you
in
feel
that
75
sheet, a
thermometer for
Recently a
letter
shown
to the writer, in
if
is
general effects.
The
measure
well illustrated in
its
simplest form
when
purpose of
administered as lukewarm
or as an
disturbances
gastric
in
acting as an emetic
enema in constipation. Here we have the simple
water for the
76
may be
Even
in these
sim-
success.
fail to
THERAPEUTIC APPLICATION.
As a
portant effects
gastric
and
in
the
intestinal disturbances.
In chronic gas-
no remedy equal
to half a pint or a pint of hot water, above 100 F.,
an hour before each meal, as may be indicated in
each case. This measure, which has almost become
a popular craze, is now receiving more appreciation
from the profession. But, like other hydriatic procedures, its efficacy depends upon attention to details.
tric catarrh,
The
originator of the
is
may
indicate, will
be
sufficient,
provided the
stomach
water
occasionally
is
five
77
irrigated
If
luke-warm
with
the diagnosis be
is
no medicinal treatment or physioby acid or pepsin which can approach this
That the hot
simple cleansing of the mucous Iming.
water does remove the mucus in mild cases I have
demonstrated by the experiment of washing the
When,
stomach half an hour after it was drunk.
however, the mucous is tenacious or in large quan-
correct, there
logical aid
tity, it fails.
It
to refer to
of this point.
water immediately
before
The mechanical
effect of irrigation
is
the most
78
summer
diarrhoea,
The method
of intro-
this
is
is
as follows:
not a
difficult
cult,
In older children
should not be
made
of anxious friends,
in the
if
it
is
more
it
by
diffi-
The procedure
it
baby, although
will interfere
The
evanescent and
not
in
denoting harm,
many
instances.
it is
con-
The
it is
is
poured.
better to dis-
is
to escape
it
will
If
be vomited.
The
in
may be referred to
branch of the subject. Its
connection with
this
79
There
it.
no
is
dis-
ease that perplexes the physician more than the various types of dyspepsia. To diagnose an ordinary
gastric catarrh or a neurosis of the stomach from
meal
is
not devoid of
diffi-
at 5:30 p.m.
long,
a chair
in front of
the patient.
It
is
placed upon
well to protect
is
if
quested to
The
sit
The
Artificial
patient
is
re-
in
warm water
(oil is
unnecessary and
Holding
it between the
he introduces it over the tongue,
until it strikes the back of the pharynx.
The patient
is now told to bend his head forward.
In the first
effort gagging will ensue, but an abundant mucus is
secreted in the throat which lubricates the tube. The
thumb and
forefinger,
8o
if he feels choked or disby informing him that this is the usual effect
and that if he will keep his mouth well open he cannot choke, because there is ample room in the pharynx
for a larger tube.
The physician must refrain from
sharing the patient's excitement, and by his calm demeanor reassure him when he, as is often the case^
protests that he is utterly unable to do his bidding.
I have failed only twice in many hundreds of instances, and I have observed that some patients, who
tressed,
at first declared
came
it
Sometimes an obstruction
themselves.
is
met with
an assistant
If
will
At times it is necessary
tion back and forth.
because
avoided,
at
found that
each
it
to
move
This,
produces gagging.
introduction
however,
is
more
should be
It
be
from
will
free
as
mark usually found upon it (which, howmay be measured in each case by laying the
far as the
ever,
mouth
an assistant,
teeth^
is
the
8i
mucus obstruct
the fen-
may become
and re-introduce
greatly,
to.
if it is
make
the
luncheon,
the
first
or
it.
Hence
initial effort.
irrigation
before
it is
advisable
six
breakfast.
by the physician's
left
is
is
stomach.
establish siphonage.
it,
still
After about a
held firmly,
is
still
flowing^ in order to
If the
may be
in-
make
to witness
This
the introduction
in
by allowing them
a well-drilled
case.
however patience, calmness, reassurance, gentleness, and skill in manipulation and overcoming obstacles will surely succeed in
is
rarely necessary,
EEE
82
in
describing the
value of details.
me
of the
when
of food have
clue
is
powers of the patient, and the latter obtains a valuIf the washings contain mucus, it is im-'
able guide.
portant to distinguish between stomach and throat
mucus.
which
The former
floats
dant,
is
a thick, tenacious,
brown mass
of the water,
like
the
mucus is
transparent, stringy, and may be more abunbeing the result of irritation by the tube of the
of a pond;
the throat
of the
mucous membrane.
Its rapid
and
treatment indicates the character of the disease affecting the mucous lining.
in this
nostic
rigations in
Various forms
-83
of
diet,
amounting
no relief.
at
times almost to
starvation,
Bismuth and magnesia, hydrochloric acid, hot water before meals, and other remedies only afforded temporary relief in the course
of several months. A sojourn in the country comafforded
pletely
restored
him.
On
his
he appren-
return
occupation being
This
washed out
five
hours
later.
small quantity of
Pain was
The
longed nervous dyspepsia, was made, and the followHe was ordered
ing simple treatment was adopted:
an aloes and mastic pill every night, a meat pulp diet,
irrigations of the stomach every second day, and
The stomach was washed
pulv. magnesia for pain.
nine times, the interval being prolonged as the course
The pain returned but once,
of treatment progressed.
it
until
he re-
sumed
84
He was
for the
more successful
dietetic
ment.
When
the case
is
origin,
symptom
mucus and
-85
several
physicians,
including
made
myself,
for
gastric
Dr. H. asked me (March 4th, 1890), after reading the account of the above cases I had given in a
paper before the New York County Medical Society,
to wash his stomach for diagnosis. Patient looked
haggard; suffered from migraine; had worked hard as
a country practitioner for eighteen years; vomited continuously, with headache; had tried everything, including rest for eight months; dieted carefully; no serious
gastric distress after eating.
An eminent authority
had diagnosed gastric catarrh, and had put him on
meat diet.
both eyes;
He
A mixed
diet
to-
him
greatly.
86
some
of these
trying cases.
management
tarrh, the
recovery.
night.
There
is
87
preference, but in those parts of this country, especiwhere the evening meal is usually about
ally in cities,
good
as a rule,
it is
morning, except
case. When,
we have a case characterized by accumu-
which
and demands large quantithe habit of washing the stom-
am
in
and women.
my
care, in
whom
free
his business.
chloric acid
in his
analyses.
particle of hydro-
partaken of them.
This case was completely relieved of his symptoms, requiring now only bi-weekly washings.
It proved to
be a case of stricture of malignant character, to which
the
patient
make
life
When
paired
finally
Lavage served
succumbed.
without
other organic
to
it.
is
involvements,
im-
as
in
resorted to habitually.
tic
purposes, while
is
had been
ill
three years; at
May
first
aet.
15th, 1889.
suffered fainting
23,
She
fits
hand, traversing body and concentrating in epigastrium, for which her father administered
a month.
morphia for
and
irritable,
and
spat up nearly
solids.
all
89
her food,
more frequently
In the
fall
She studied
tonics, pepsin,
and
all
Had
Gastric
neurasthenia of the
pure
When
90
retention of undigested
duction of decomposition are due to pathological dilatation, and thus impair the motor functions, lavage
may be
It will
in
is
neces-
be useful as an
Life may be prothis simple
hydriatic procedure.
may
stomach
walls,
In
all
is
per-
An
occasional
of
irrigation
cleanses
the
91
The
acts as a
walls,
etc.,
in
and aids
restoring
its
tone.
GASTRALGIA.
In this painful malady, even when not dependent
upon accumulated fermented material (which, by the
way, IS its most frequent source), the irrigation with
hot water acts as would a poultice to an external
sensitive
part.
Kussmaul's
striking
Clinic.
case
woman,
is
22
reported
from
years of
age,
agonizing gastralgia,
remedies,
including
blisters, etc.,
electricity,
habituated to the
tered
the
clinic
in
miserable
condition,
feeble,
Diet, rest,
from hypodermatics, etc.
required.
still
etc., were unavailing; morphine was
water
warm
with
irrigated
Her stomach was now
returned
water
The
empty.
morning,
while
every
This was continued
almost clear and a little acid.
cicatrical knots
with advantage to pain and renewal of appetite. Carbonized water, mixed with plain water at 100, was
In three
now substituted, 2-3 litres being used.
Warm
baths at
etc.,
now administered
92
The morphine
To aid in
injection gradually
became
less necessary.
obtaining spontaneous actions of the bowels faradization was produced by introducing a wire electrode
filled
stomach, and
minutes.
in the
to.
INTESTINAL OBSTRUCTIONS.
ered by Kussmaul
more
anxiety.
air,
the
opiates
remedies
to
which many
cases,
even
appreciation.
The
first
into
his
case
by
March,
treated
hospital in
usual
93
maul
all
One
large
irrigation of the
when
surgical
interference
became
otomy than
hitherto.
In a case occurring in
my own
service at the
in a case of stenosis
lull
94
them.
is
here
an extreme case.
COLIC FROM GALLSTONES.
Although
the faeces.
result
from
commends
it
repro-
when we
cases.
This
of infants
is
95
and
elastic,
It
its
length
should be attached
drachm
solved.
The
of chloride of
infant
is
The
The
anus.
is
is
now somewhat
may
tube
dis-
Whenever
in-
meets an obstruction it
should be withdrawn a little and gently persuaded to
pass upward. If the water is allowed to flow and distend the bowel, introduction is greatly facilitated.
testinal canal.
Remembrance
the
mortification
Sometimes
it is
it
of
more
abandoning
the
readily introduced
When
me
introduction.
when
discon-
farther,
96
Experience
has
convinced
me
that
thorough
by the
physician or by a competent nurse, under special instruction, every four or five hours, lessens the
number
the case
RATIONALE OF ACTION.
J.
L.
in
summer
diar-
in fourteen
The
all
it
is
just
97
far as possible.
neutralized.
An
the stimulation
is
While
injections produces.
dysentery, resorted
to
asmuch
made
sufficiently
endangering
without
mucous membrane,
or
the
of
the
poi-
integrity
Further investigations
Cantani's
cholera
may be
method
of
here imitated.
tannin
He
may
For
irrigations
has succeeded
in-
in
in
the
CATARRHAL JAUNDICE.
About
cian, treated
7 EEE
Dr. Krull, a
German
physi-
After
succeeded,
later,
relieving
in
first,
Lowenthal reports
(Berl.
the
the
re-establishing
in
constipation
hepatic
norm.
and,
Dr.
forty-one
cases of catarrhal
64
F.,
increasing three
In
each case.
all
followed
temperature.
Grey or
became
headache,
etc.,
first
treatment;
and
after the
ond
slightly yellowish,
if
somewhat higher
irrigation.
Pruritus,
first,
among seven
cases,
disap-
tients; in
of the digestion;
99
ure, so that
testify
in
gallstones.
in the
and
this increase is
From two
In
more
reached.
my own
is
continued until
after the
first
injections,
jaundice disappeared
failed in
subduing the
DYSENTERY.
In acute dysentery of infants, as well as of adults,
irrigation
aseptic
with
by long
proved
made thoroughly
in
the hands of
re-
is
rest
the chief
action of water.
which
in
all
inflammatory
They demand
careful attention to
How
me
not to do
it
illustrated
by the case
hydriatic measure
is
readily obtained.
The most
re-
Medical Age,
Korytin (Russia) de-
find in the
Dr. Peter
S.
tails fifteen
water, which
is
pints
of
distilled
lOI
therefore, that the beneficial results of the treatment
LEAD
Reisland published
COLIC.
Wochen-
bile;
The
teeth presented a
scybala.
He
obtained so
much
upon a repetition.
duced, and were followed
insisted
On the following
litres brought stools and relief.
day the pain and spasms returned, and were again relieved by irrigation. He received one more irrigation
I02
which brought a good faecal evacuaand he was assisted to entire recovery by a dose
In
of 01. Ricmi and 01. Crotoni and a warm bath.
Kussmaul's Clinic at Freiburg this treatment has
been used for many years. Whether lead colic be a
neurosis of the intestinal muscular coat, or, as Riegel
deduces from the effect of amyl and pilocarpine, a
of three litres,
tion,
of water (66 to 105 progressively) through the intestines excites peristalsis (Malbrane, Berl.
Klin. W.,
1878).
WATER
Another
of water
eases
of
is
IN
GYN/ECOLOGY.
the
ated.
If
Dr. T. A.
I03
nothing more
would be great
indeed.
details
He
But here, as
water
as a
the
claims,
impossible
is
it
F.).
for
and therefore
ing,
So different
tonic, effect of
Emmet
by
discovered
is
digital
examination
a series in the
Emmet,
those
Woman's Hospi-
"We
the corrugat-
these injections,
their guidance.
Whenever inflammation
congestion of the arterial capillaries, and when it subsides there remains, among other results, a condition
erroneously termed chronic inflammation, a condition
essentially the same as the one just described, attend-
it
is
in the vessels
and an obstructed
it is found
a misnomer, since
existed.
The
usual seat of the so-called inflammation, and the circumstances under which it is generally found, have
we
pelvis.
The
use of
equally beneficial in
104
is
Yet, so beneficial
is
it,
ex-
believe,
be found blanched
As
its
be
The
hot water
will
lie.
The
then be
in
contact with
from
the cervix and body of the uterus pass along the sul-
I05
If,
we
we
influence
the
most important to appreciate the necessity for elevating the hips, by which
plan so large a portion of the venous blood becomes
drawn off by gravitation. If the stimulus of the hot
water
is
-contract
It is
more, we
shall, for
its
natural
longed as possible,
succeed eventually
tone.
No
in
securing
we
proper vascular
the
of
shall
injections,
7ieglect
is
although so
of
But,
details, it is rare
many
mode
io6
of action.
it is
an impossi-
advantage
is
Not the
when ad-
for,
and elbows or
is
In this position
chest.
of the
able to act on a
than
But
it
is
when
this position
those
who
much
the patient
is
is in
any other
position.
it
is
also experi-
enced in keeping the patient dry. This latter, however, can in a measure be overcome by using a funnelshaped receptacle with an india-rubber tube attached
to the smaller end, the two sides being indented suffi-
107
it in place by
have also used an
inclined plane to elevate the hips; it should come between the legs and have a hole large enough for the
buttock, so that the water may flow into a receptacle
These methods, or any other which the ingebelow.
nuity of the physician may suggest, can be employed,
so long as the action of gravity is brought into play
and the vagina is fully dilated by the water. But, for
the largest number of cases, the position on the back,
with the bed-pan to elevate the hips, will be found the
Few women
most convenient.
are so situated as to
details
of
can
waste
When
the early
under treatment, it is
necessary that the temperature should be elevated
rapidly from that of blood heat to iio, or to as high
a degree as can be borne by the patient, and that the
For ordinary
injection should be often repeated.
use a gallon of water, two or three degrees above
blood heat, is generally suflicient, but the temperature
stages of
inflammation are
must be maintained
by the addi-
The hour
of
bed-time
is
io8
upon the
local
irrita-
prolonged vaginal injection, at a high temperature, will often, when given by an experienced
hand, act with more promptness than an anodyne in
tion; for a
woman.
and
be but
little
to
disturbed
usual temperature.
In some instances so
much
dis-
more discom-
fort
to employ."
I09
resulting
benefits
from
this
valuable measure.
WATER
IN SURGERY.
modern times
of
in
latter, is
means
the recognition
of rendering
wounds
More
lives
method
if
we
briefly
com-
now
presses
of
in
patent
lint,
were applied, and these were carefully held in position by bandages and moistened from time to time.
no
common
complications of
and gangrene, and the comparative immunity from these undesirable complications under the modern dry treatment of wounds,
amply demonstrate. The modern idea would elimiDurnate water from the treatment of most wounds.
ing amputations, resections, and other operations, cold
water was freely poured over the field of operations
by means of large sponges. How much more gentle
is the modern method of irrigatifig the exposed strucerysipelas, septicaemia,
tures;
management during
operations.
It
appears to
me
that the
for
volved
in
in-
amputations.
It is one of the triumphs of water in modern surgery that experience has demonstrated the value of
boiled water as an antiseptic in laparotomy.
The
conviction
mind
gical
is
if
temperature during
attended
to.
its
of the water
The
it
is
must be
ETC.
prevent shock
is
referred to here
of
modern
origin,
to demonstrate the
measure.
They
contrasts
favorably
is left
it is
In
filled
that
what
is
its
abuse
after operations.
The
112
of
the
wound from
practiced, by repeated
rest
which
dressings
is
the
disturbances hitherto
cleansings and
ablutions
the
enormous
many
that
if
corro-
have been
of the
field
fulfilled.
of
and thorough
all
be
indications
of the
wounded
soap,
surface
in
stint
Then
it is
cleanliness will
113
mental.
is
it
now
a recog-
Formerly,
gether.
was regarded as a
sine
disease.
That
this is
an
error,
personal
experience has
remember a
young colleague who suffered from a chronic eczema
of the hands, for which he had been unsuccessfully
treated secundum artem by zinc, tar, and other ointments, and rubber gloves.
The suggestion to refrain
from washing the parts led to an early recovery.
Many
well
my observation.
especially because
come under
modern observation
of which
in
the
frequent injection of
ing
media.
otitis
when
a practice which often maintains the supmacerating the inflamed and, sometimes,
fungoid edges of the perforation, and proving a serious obstacle to recovery. The simple refraining from
that this
is
puration,
EEE
injections
IT4
me
results
in
the
days.
IN
third
water, which
am
local
use
of
is
the injection of
warm
is
after the
comparatively
retained
secundines,
absteiition
from
agement
first
these
injections
rule of
man-
of the puerpera.
labor and
in
115
may prove
they
the enemy, to
whom we
deny entrance,
into the
among
the
That
present day,
school
singular at a time
it
when modern
eschew
digital
examinations.
(Leopold, of Dresden,
Hence
the author
is
warranted
in
upon water
from
use water as
is
powerful for
evil
as well
REVOLUTION IN
IRON AD MINIST RATION
A HIGHLY PALATABLE PREPARATION OF IRON
CHLORIDE.
IRON
is
easily chief
among
Hsematinics.
According- to T-
D.
&i
CO.'S)
We
earnestly recommend its trial to all the profession, believing it to be the most acceptable preparation of iron ever
devised.
Samples will be sent on receipt of request to physicians
who indicate their willingness to pay express charges.
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