It is advisable to commence with water at about the temperature of 7o° F., gradually cooling it to 5o°, or if the fever is high ice may be added; on the appearance of any symptom of collapse or shivering the sponging should be suspended or water at So' or 90` substituted for the cooler fluid.
Baths are employed at various temperatures; thus in Brand's routine a temperature of 6S° F. is the standard, but as a rule no advantage is obtained from plunging a lever-stricken patient into water which feels to his burning skin to be very cold. By commencing w ith the water at S5' shock and discomfort are prevented, and further reduction of the heat can be gradually accomplished by adding cold water. In hyperpyrexia no time should be lost by tempering the bath to the feelings of the patient, who should be at once placed in a bath about which can be further reduced.
For routine practice the bath in average cases of severity should be given every 3 or 4 hours, and the duration of the immersion need not exceed 15 to 20 minutes to reduce the patient's temperature in the rectum to about ioo°. As a rule a drop of about should suffice in all mild cases. After being lifted out of the water in which the entire body has been immersed (save the head), whilst the patient keeps in the horizontal position he is placed on a blanket and the surface of the body lightly dried by a towel, leaving the abdominal surface to dry spontaneously. Usually it will be advisable, certainly at first, to give a small dose of Alcohol or a little strong and warm beef tea before the bathing process is commenced, and this may he repeated to advantage after he returns between the sheets, whilst any chilling of the lower extremities should be counteracted by placing a hot-water bottle at the feet.
In severe hikmorrhage and in great tympanites with signs of local peri tonitis indicative of deep ulceration, resort to this method is certainly attended with a considerable degree of danger. When great cardiac depression is present the temperature of the bath at first should not be under and a full dose of Alcohol may be administered whilst in the bath, and a hypodermic of strychnine given previously.
The great drawl iicks to the Brand treatment of typhoid fever are the necessary movement of the body entailed by repeated bathing, and the difficulty of carrying it out without relays of trained nurses, especially in heavy subjects. It is only in a well-equipped fever hospital that the
routine can be carried out to advantage, where a large portable bath on 1l heels can be brought alongside the patient's bed, and three nurses are usually required to carry out the necessary manceuvres whilst lowering the body in a sheet into the bath.
To obviate the dangers of changes of position and the consequent temporary increase of abdominal pressure innumerable forms of apparatus have been designed, but as yet none can be said to be quite satisfactory. Dr. Bull' Ja.rAintosh portable bath is the best of these.
The continuous bath introduced by Barr consists of a tank 6 feet by 3 feet by i foot, in which the patient lives for 3 or 4 weeks surrounded by water at a temperature of 90° to 98°, with a blanket wrapped round his body and a pillow sufficiently high to keep his head above water. A large opening in the bottom about the centre of the tank is provided for the rapid draining away of the water when soiled by bowel evacuation. Excellent results are stated to be obtainable from this hydropathic method, which obviates the dangers liable to follow movements of the body.
Various forms of chamber have been tried in which the abstraction of heat is effected by cold air, the patient's bed being wheeled into the chamber at intervals. By employing a tubular mattress connected with a freezing or circulating apparatus, a similar effect may be produced. These methods are all most unsatisfactory in their working. In the case of children a cooling apparatus may be extemporised by placing a large cradle over the cot, and hanging this on the inside with a number of small ice-pails, a sheet being thrown over it as a cover whilst the surface of the body is exposed to the influence of the reduced air temperature.
Leiter's Coils have been used and ice bags or iced poultices employed, but all these methods of abstracting heat are much inferior to the direct application of water.