Careful judgment is to be employed in giving the bath to children. Some do not bear the plunge at all well. There is, as a rule. at no period of childhood the need to use water at as low a tem perature as in the case of adults. At the Children's Hospital of Philadelphia it is the custom to employ the graduated bath, placing the child in the tub with the water at a temperature of 95° and cooling it down to S5°, or occasionally. with older children, to less than this. Very frequently, sponging answers every purpose. Even a tepid bath may some times answer well. Hydrotherapy is not to be used as an unalterable plan of treatment. J. P. C. Griffith (Phila. Med. Jour., Oct. 15, '98).
Tepid-bath treatment of typhoid fever used instead of the cold bath in the fever wards of the Brisbane Hospital. As the result of many thousands of baths, the following conclusions are warranted: 1. The average fall of temperature obtained through these baths is 1.5° to 2° F. 2. In a large number of cases a bath of S5 degrees will bring about a greater reduc tion than one of SO degrees of the same duration. 3. In a small number of pa tients (principally the aged, the weak, and children) a bath of 90 degrees is more effectual than one of 85 degrees. 4. There are a few cases that offer considerable resistance to refrigeration through tepid baths. Hirschfeld (Ther. Gaz., May, 1900).
The nervous system of the child re sponds more quickly and energetically to the cool bath than does that of the adult, and to some extent in inverse proportion to the age. It is therefore undesirable that as low temperature should be em ployed in the ease of a young child as in the case of an adult. A bath of 90 degrees cooled to 55 degrees and repeated regularly for the first few clays gives rise to neither resistance nor shock nor col lapse. Later on lower temperatures may be employed if necessary. A. D. Black ader (Archives of Pediatrics, Sept., 1900).
In the treatment of typhoid fever hy drotherapy has attained its greatest rep utation. Professor Vod,medical direet(r of the Bavarian army, furnishes a record of 6325 eases of typhoid fever treated in the course of 47 years in the Hospital at Shmich, showing a reduction in mortal ity from 20 per cent., under the expectant plan of treatment, to 2.7 per cent. by the cold-bath treatment. lie shows that in testinal haemorrhage, perforation, peri tonitis. puemnonia, and other complica tions have been greatly reduced. Brand published a record of 5573 cases with a mortality of 3.9 per cent. Jorgensen pub lished the records of the hospital at Kid. From the year 1850 to 1861 330 cases were treated under the expectant plan, with a mortality of 27.3 per cent. From
1863 to 1866 160 eases were treated by the Brand method, with a mortality of 3.1 per cent.. All these men insist that the Brand treatment, to be successful, must be rigorously carried out. They do not claim that it is a. universal pana cea. The duration of the disease is short ened, only in so far as complications are avoided. But the patient is left stronger than after the expectant plan of treat ment. and convalescence is more rapid. As an antipyretic it is safer than drugs. The Brand method, as Parried out in most of the large genera] hospitals, is as fol lows: Every three hours, if the temperature be 102.5° F. or over, the patient is placed in a bath, which has been wheeled to the bedside. The temperature of the water is about 70° F. The head is supportel and cold water is poured over it, whi‘e general friction is applied to the body.
The patient remains in the bath from fifteen to twenty minutes and is then re moved, wrapped in a dry sheet, covered with a blanket, and put in bed. Ile is then given a stimulant. Neither bron chitis nor pneumonia is considered to be a counter-indication. J. A. Shields (Brooklyn Sled. Jour., Mardi, 1902).
— The night-dress and bedclothes are removed under a sheet by which the patient remains covered. If he is sweating, he is rubbed dry. The bath-tub is filled outside of the ward to within six or eight inches of the top.
Canvas strips are used to support the patient in the tub. These are thirty-six inches long and of a width varying from eighteen to thirty inches. They are fastened across the tub to the edges of the bath by clamps which are easily re moved. The canvas strips are placed so. as to form a sort of trough in which the patient lies. Their exact arrangement has to be made after the patient is in the tub. The strip at the head of the tub may be clamped all around the end as to form a support. Two persons lift the patient covered by the sheet into the bath. The attendant lifting the head slips his hands under the shoulder, and puts the patient's head in the hollow of the arm farthest away from the bath. A second attendant takes the feet, and the patient is directed to hold himself stiff when he is lifted into the tub and lowered gently into the water. The sheet is used as a covering. The strips should be so fixed that the water just covers the patient's chest. The head should be supported on a ring or air pillow. The patient is rubbed regularly, constantly, and systematically either with a bare.