BATHING - GOUT - TREATMENT HYGIENIC AND PROPHYLACTIC .
Baths of all kinds may be employed with considerable advantage, if rightly used. But it must be always kept in mind that arthritic subjects are far more sensitive than others to heat and cold, and to variations of temperature. For this reason, if for no other, such persons must exercise more than ordinary caution in the matter of bathing. Since the act of taking a bath is in many respects equiva lent to active exercise, the same rule that applies to muscular exer tion should control the use of baths. Moderation is the rule. The patient must not indulge too frequently nor for too long a time. The age and vigor of the subject should also be taken into consideration. For young and vigorous people, whose viscera are still in a healthy condition, cold plunge-baths may be permitted. If the patient be of a delicate organization, cool sponge-baths, followed by vigorous friction with coarse towels and brushes, should have the preference. But if there be feeble reaction after the bath; if there be an abiding sense of chilliness, with a cyanotic hue upon the skin, cold bathing must be forbidden, especially if there be any suspicion of renal insuffi ciency. In all such cases, warm baths are indicated. The particular kind of warm bath must be ordered after careful examination of the individual peculiarities of the subject. Warm-water baths are to be recommended for those who can remain indoors during the greater part of the time, and for the victims of renal or hepatic or nervous disorder. The bath should be of short duration, and should be followed by repose in bed for an hour before exposure to cold air. Such a bath may be taken in the morning before breakfast, and followed with a cup of hot milk colored with tea or coffee; then, re turning to bed, the patient will easily sleep till noon, when lie should dress, and partake of a temperate breakfast according to the diet-list recommended on a previous page. For patients who are full-blooded or who are suffering with obesity, considerable caution is necessary, for they are often greatly debilitated by long immersion in hot water, and by the copious perspiration that follows. Such persons should take dry hot-air baths, if heat be desirable, since they are more stimulating than vapor baths or warm-water baths. Many patients who experience a sensation of suffocation in a Russian steam bath can sit in the hot room of a Turkish bath with perfect comfort. Whenever there is a tendency to bronchial catarrh, or when the heart is enfeebled by any cause, dry hot air is much more tolerable than moist heat. In the majority of cases that can tolerate these baths, the ultimate effects are beneficial. At first, there may be complaint of exhaustion and depression of spirits, for the reason that perspiration increases the alkalinity of the blood and its power of holding orates and other nitrogenous substances in solution. Thus dissolved they are conveyed to the nervous centres, where such sub stances as paraxanthin, gerontin, etc.., exert their toxic influence, which is manifested under the form of exhaustion, debility, and ex treme mental depression. After a time, however, especially if the diet be properly regulated, and the hepatic excretions be aided, these substances are so far eliminated as to produce a complete change in the condition and feelings of the patient. The first experiences of one who undertakes a course of such baths cannot, therefore, deter mine the final result.
Sea-bathing is usually the equivalent of a cold bath. It is only permissible to those who are young and comparatively healthy. Through the constringent effect of cold, the perspiration is checked and the blood becomes less tolerant as a medium for the solution of nitrogeuizecl substances. Urates and their congeners are, however, not diminished in the urine unless the patient is kept on a rigid diet. When people visit the seaside their baths and exercise usually cause an increase of appetite which they gratify without stint, unless kept under medical supervision; hence occurs a considerable increase of urea and the other nitrogen compounds in the urine. An intelligent oversight is therefore necessary in order to keep the balance even between the elimination that is due to baths, exercise, and bracing air, and the nitrogenous intake that is increased by an improving appe tite. Still, it will be ordinarily found that, like all other forms of
activity in the open air, the influence of sea-bathing is very whole some. it is excessive indulgence and exposure to chill, with conse quent disorder of the liver and kidneys, that are to be avoided in every case. Hydropathic treatment is unattended by many of the dangers that accompany the ordinary use of baths. For young and vigorous subjects it is an admirable. expedient; hut fie the old and feeble it must be employed with great caution. The use of cold douches and other similar methods of applying cold water must be guarded by the same precautions that are necessary with regard to cold baths. It is wise to form in youth the habit of cold sponging of the surface, for then the practice can be continued through life with great advantage to the patient; but to begin the use of the sponge bath at an advanced age, after the constitution has been undermined by disease, is not without considerable danger. Still, when the heart and kidneys are yet intact, great benefit is sometimes obtained from cold affusions followed by vigorous friction and massage. Horace has recorded his indebtedness to these methods (Epist., Lib. I., 15) " Baias Musa supervacuas Antonius, et tamen illiS Me Tacit invisum, gelida cum per]uor unda Per medium frigus." And it was by similar advice to the Emperor Augustus that Antonius Musa acquired his great reputation in ancient Rome. Especially valuable is this practice during hot weather, when the patient is de bilitated by heat and excessive perspiration. If possible the treat ment should be commenced under medical advice in a well-appointed hydropathic establishment, and then its good features can be perpet uated subsequently at home. But for elderly people, it is generally necessary to avoid all sudden chilling of the body ; dry friction and massage, either with or without the application of aromatic and stim ulating liniments, are decidedly preferable. In this way the healthy function of the skin can be most efficiently secured. The inordinate sensitiveness of gouty people renders it also necessary for them to guard against the impressions of atmospheric change. They must wear flannel underclothing throughout the year, shifting from heavier to lighter stuffs during the summer, but never abandoning woollens altogether. Such patients perspire abundantly upon the slightest provocation, and frequently they experience night-sweats that remind one of the clamps of tuberculosis. For this reason, it is often ex pedient to wear thin woollen night-gowns instead of the ordinary cotton garments. During the colder half of the year elderly subjects derive great comfort from flannel sheets on their beds at night, par ticularly if there be a tendency to perspiration or to coldness of the feet and legs. Whenever their circumstances will permit them to enjoy the luxury of travel, they should become birds of passage, seeking to pass the months of autumn, winter, and spring in countries where the air is dry and warm. For this purpose, the interior regions of Algiers, Tunis, Arabia, India, and CPylon, the West India Islands, Southern California, certain portions of Mexico and Central America, and the Hawaiian Islands can be confidently recommended. If such liberty of choice cannot be afforded, it may still be possible to find a home at a distance from the ocean, or any other large body of water. Even a cold climate is preferable, if it be dry, to the chill and clamp that prevail along the sea-coast. In this respect the air of mid-ocean is far more tolerable than the fogs and rains that veil the northern shores. For those who are fond of sailing, a long voyage is often beneficial, especially if it be taken in an old-fashioned sailing-ship, slowly gliding through the trade-wind belt, where for weeks together the temperature of the air and the stainless blue of the sky remain unchanged. There, remote from the toil and turmoil of civilization, can be found such rest as no other spot on earth affords. And if at the end of the passage lies the Cape of Good Hope, or Australia, or Northern New Zealand, or the Isles of the Blest, he must be indeed an arthritic veteran of the most obdurate sort who does not experience a renewal of youth and health under these favorable conditions.