The hot bath was formerly given only to produce sweating, but it may also be used as a revulsive or a stimulant. Thus, hot baths (up to 40° C.; 104° F.) have proved their value in the afebrile stage of epidemic cerebrospinal meningitis, and these may be of considerable value in the most varied conditions of weakness, and may even he given to infants. In flabby, scrofulous, or aniemic children, who are not high-strung, warm or eyen hot baths may be given according to sonic definite plan two or three times weekly for a period of four or live weeks. If it is desired to the action, the patient is kept in bed for several hours thereafter. If there is danger of making the patient too susceptible (tender), or if greater stimulation of the nervous system is desired, a quick cold douche is given by pouring water upon the nape of the neck from a pitcher or a. sprinkling can. A cold douche is an excellent procedure after a cooling bath, increasing its stimulating effect and tending to cause a deeper respiration. When the bath is but the initial step in a combined water treatment, this douche must not he employed, as one may, for instance, follow immediately with a pack. A cooling bath is but rarely supplemented by a cold pack, whereas a hot bath is very frequently used as a preparation for the full pack, which is to induce sweating.
Between the hot and the cold full bath lie the "indifferent" full baths at 34° to 35° C. (03° to 95° F.), which act as a sedative or hypnotic, especially when of long duration (about one-half hour). Spastic con ditions, even when of organic origin (as in cerebral palsy), are relieved, so that passive movements may be made more readily while the patient is in the bath. Mental excitement is allayed, mental strain is relieved, and sleep, which has been absent, occurs more readily after the bath.
A similar but less marked action is obtained by means of the sitz bath. The lower part of the body and the upper portion of the thighs are immersed in a wooden tub, or an ordinary hip bath tub, or, in the case of very small children, in a very deep bowl, the upper portion of the body being protected from exposure by a large bath towel. The temperature should he between 33° to 30° C. (itI° to SG° F.) and the duration from three to ten minutes. As the reaction produces a conges tion of the genital organs, this procedure should be avoided just before bed time. Sitz baths are of value in all comtitions of nervous irritabil ity (chorea, cephalalgia), but particularly of the genitourinary system (enuresis, onanism).
In considering the half bath, we conic to the measures which act as nerve stimulants, of which measures others will be mentioned. Of the previously described procedures, the cold full bath should be in cluded in this class, excepting that it is not, as a rule, used for children, at least so far as a tub bath is concerned. On the whole, it has been
found that none of the procedures which have a markedly stimulating effect upon the nervous system may be used too vigorously or for too long a period. By proper application and with due regard for individual susceptibility, the nervous system may be refreshed and strengthened; whereas, on the other hand, much harm may be done by overstimula tion where this susceptibility is not considered.
The half bath reaches to the umbilicus of a child when sitting in the tub. in the case of smaller children, the difference between a half and a full bath often disappears. Only at the end of childhood may the half bath be given as cold as is generally advised, i.e.. 2S° C. (82° F.), with a douche at 15° to 20° C. (59° to 6S° F.), and even then a temperature somewhat higher, 30° to 32° C. (SO° to S9° F.), is to be preferred. The arms and legs are rubbed with the water of the bath, which is at the same time poured over the chest and back, and toward the close the colder water is poured over the patient, the pitcher or other vessel being held as close to the skin as possible. Contrary to the usual advice to continue the procedure for ten to fifteen minutes, it will be found that three to five minutes will prove sufficient.
Another procedure which is very stimulating is the cold rubbing, which has the advantage of being readily given in the bedroom with out much preparation. A bath towel which is slightly longer than the patient and wide enough to be wound twice around the body is dipped into a pail containing cold water, at first about 30° C. (SO° F.) then gradually at room temperature, and finally as it runs from the tap or spring. After having been wrung out (as much as possible at the beginning of the treatment, later on perhaps not so much), the towel is wound round the child (who must be standing) as quickly as possible, passing it under the outstretched arms at the first turn and over the arms, which have been dropped to the sides, at the second turn, so that the towel will then be smoothly applied to the body from the neck down. Then with the flat of the hand, one anteriorly and the other posteriorly, the body is rubbed with long strokes through the towel, until the pack becomes warm. It is then quickly thrown off, and is replaced with a dry towel, which is used to dry the patient. After this the feet and legs of the patient, who is now seated, should be rubbed energetically and dried. A wet compress to the head during this pro cedure is unnecessary in the ease of a child. Only weak and anaemic patients should be permitted to go to bed after this; as a rule the child is quickly dressed, and sent out into the open to exercise freely.