The Secrets of Specialists/Chapter 5

Other than light baths, constitute one of the most ancient of therapeutic measures, and the healing properties of water could be traced back to the most remote ages of antiquity. The ancient Romans not only utilized baths as a panacea for all ills, but as a means of invigorating and strengthening their armies, and wherever their subjects were stationed, Image missingRuins of the baths of Caracella. elaborate bath accommodations were installed. The gigantic magnitude of these establishments is well illustrated in the ruins of the baths of Caracella, which are still in existence. Similar baths were located in its most distant possessions.

In the ancient city of Bath, England, there was a Roman bath establishment restored only six years ago, A. D. 1909, as it existed during the time of Cæsar. The baths of Rome and Roman possessions finally lost their significance, and for many centuries. the art of bathing, as formerly practiced, fell out of existence; and only within the last sixty years has the therapeutic value. of baths evolved into a scientific system of hydrotherapy.

The scientific technique of hydrotherapy, as it is practiced today, supplemented by the use of all modern bath apparatus, places hydrotherapy among the leading healing adjuncts to medicine. A knowledge of the value of hydro ​therapy and balneotherapy is indispensable to any physician; this is especially true where a fully equipped office or a small sanitarium is conducted. A public bath establishment is a remunerative proposition in any locality with a population from two thousand upwards, and will not only reimburse the physician's income several hundred dollars a year from the baths alone, but will be the means of having your bath patrons become acquainted with your other scientific therapeutic apparatus, and establishing your medical and surgical business. With this object in view your bath apartment should be open to the general public, other than invalids; this can be certain days in the week, or certain hours of the day, as preferred, depending upon the extent of patronage. Most physicians, who are conducting these establishments with limited space, have ladies call at certain hours or days and gentlemen at other hours or days; for instance, the ladies' days would be Monday, Wednesday and Friday, while the gentlemen's days would be Tuesday, Thursday and Saturday. On the other hand ladies can visit your institution in the forenoon and the gentlemen in the afternoons and evenings. Of course this could be arranged to suit the demands of individual cases, etc.

You will require the services of both a male and female attendant, and it is the physician's duty to instruct these attendants in the technique of giving the different baths, massage, alcohol rubbing, etc.

It is advisable when establishing a bath institution to incorporate as many different forms of baths as possible and establish a schedule of prices ranging from 25 cents up. The following prices are those generally adopted at bath establishments:

Of course these prices could be changed to suit individual requirements.

The physician who has not given this phase of the subject special attention, may think it an exaggeration when I state that the patronage from baths alone will be the means of increasing his yearly income from one to two thousand dollars a year, even with limited equipments, and at the same time, will be the means of reinforcing his professional business to fully this amount. Of course your success will depend, somewhat, upon the amount of energy expended in making a bath institution popular. Nearly all physicians, conducting bath establishments in connection with their practice, issue bath tickets, from which they make a small reduction where a course of baths is given. To illustrate the common, hot, or cold baths, with alcohol rub, which are listed at fifty cents for a single bath, a bath ticket is issued giving a course of twelve baths for five dollars. Bath attendants usually expect to make a fair salary from the "tips" they receive, and they can conduct the baths for you on either a salary or commission.

Baths have been defined as the process of complete or partial immersion of the body in some element or substance other than that to which it is normally accustomed; thus we may have hot or cold water baths, hot air, vapor, or medicated vapor baths, sand, mud or sun baths, electric or electric light baths, etc. These baths may be given for pleasure and cleanliness, as surf bathing in the ocean, or for therapeutic purposes, for their effects upon elimination, stimulation, metabolism, etc. The temperature of baths varies, generally, from forty to four hundred degrees F., depending upon the substance used and the method of application. The following temperatures are the standard in general use:

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To determine the temperature of baths the physician should provide himself with a bath thermometer. This is a very important instrument especially when you are keeping a record of bath patients.

It is the universal opinion that heat and cold, applied to the external surfaces of the body will be conveyed to, or abstracted from, the deeper tissues; while this is true to a certain extent, the process of penetration, or depletion of heat or cold is very much overestimated. Various tests have been made by inserting a thermometer in the orifices of the body, the mouth, vagina and rectum, and the most accurate observers have noted only a fall of temperature in typhoid fever from two to four degrees by the use of Brand baths and their modifications, while a rise of temperature to an equal number of degrees has been observed by the use of hot baths in cholera. One of the most important objects of hot and cold baths is the regulation of circulation, when we consider the fact that the skin is capable of retaining one-half of the blood in the body; and by immersing the body in either superheated water, air ​or vapor will relieve blood pressure upon the internal organs. Every physician is familiar with this effect in convulsions of children and even adults. What is true in relieving the blood pressure in the cerebro-spinal axis, is also true with the portal system and other congested areas.

Therefore, the physician should exercise much judgment in adjusting the temperature for a bath for certain people and not aggravate any state of the system that cannot tolerate such influence. The principal things to note are the conditions of the heart and blood vessels in either too cold or too hot baths, bearing in mind that cold baths contract the capillaries to some little distance below the skin and drive the blood pressure inward, requiring forced cardiac pressure, while hot baths weaken the cardiac action by drawing the blood from the internal circulatory organs.

From time immemorial, the laity have been taught that the only way to derive benefit from baths is to emigrate their anatomy to some fashionable mineral springs or bath resort, where the waters have an obnoxious odor, or nature has provided water at an increased degree of temperature. This is illustrated by the patronage of the three principal bath resorts in this country. Mt. Clemens, Michigan, is noted the world over for its mineral baths, while the Hot Springs of Arkansas and Virginia are famous for their super-heated waters. One great advantage regarding these resorts is that nature has provided surrounding scenery which is attractive to the invalid, and produces a degree of tranquility to the nervous system which could not be obtained at home.

The therapeutic value of the minerals contained in bath water is very much overestimated. This has been proven conclusively by many authenticated clinical tests. While there are many medicinal products which are capable of being absorbed by inunction, Dr. R. Winternitz has found it impossible to induce the direct entrance of these substances into the skin from watery solutions.

Dr. Rohrig experimented with iodine, and after remaining in a strong iodine solution for three-quarters of an hour, failed ​to discover any iodine in the urine. Dr. Stas made similar experiments upon himself, using sodium arsenate. Although he occupied the full bath for prolonged periods no indication of absorption was observed.

Strong mercurial full baths have also been experienced with the view of producing salivation, and only negative results have occurred, which, from a clinical point of view, have demonstrated the inertness of medicinal substances in bath mediums. These unsettled facts of long-cherished ideas, among medical men, that in order to receive the full benefit of baths, certain minerals should be incorporated in the bath waters, are now regarded as pseudo therapeutic measures.

If we were to compare the bath records from the mineral baths of Mt. Clemens, Mich., and Hot Springs, Ark., with the records from the Battle Creek, Mich., and other sanitariums, we would find the therapeutic value of hydrotherapy equal in every way to balneotherapy.

The question naturally arises: then what advantage does the mineral bath have over the ordinary bath? First of all, it is more cleansing; this is especially so where the waters yield an alkaline reaction and an elevated temperature. They have a more stimulating action upon the sweat and sebaceous glands and also allow a freer desquamation of old skin, and contact of the water with the body proper. There is a stimulating effect upon the skin, produced by the chemicals, which aids materially in the eliminative process, while saline or gaseous baths also affect the circulatory and nervous systems in a reflex manner. The same is true with the hot or cold baths, and the greater the departure from the normal temperature of the body, the greater will be the effects upon the reflexes through the central nervous system. Dr. Wood has pointed out, with much method, that heat and cold are conditions of the same force, and depend upon the caloric intensity above or below the normal temperature of the body.

Modern chemistry has served the noble purpose of giving us the exact chemical constituents of nearly every mineral water in the country, and has also provided us with a means ​whereby nearly all mineral baths can be procured in any locality if so desired. In order that the reader may become familiar with the technique and therapeutic value of baths as used at these sanitariums and watering places throughout the country, I will outline the methods of giving these baths as used in modern hydro-therapy independent of the chemical constituents of the waters.

There are two essential things required to conduct hydrotherapy in connection with a medical practice: first, a good quality of water, and second, the proper apparatus with which to utilize the water.

If you are living near a natural spring, or can obtain an artesian well in the locality of your sanitarium or office, so much the better, as water from this source is usually of good quality, and is held in greater esteem by the general public. For the purpose of elevating this water to a sufficient height to secure pressure throughout your offices, a hydraulic pump or windmill is often installed. Of course where water is used from the city waterworks this is not necessary. Your bath equipment can be as limited or extensive as you desire, but the maxim, "the best is none too good," is always the best policy to follow. I, therefore, refer the reader to the accompanying illustration, which outlines the arrangement and equipment of a modern bath apartment. These are stationary fixtures; portable apparatus can be added to administer baths at the bedside of the sick when desired, or these elaborate fixtures may be duplicated by less expensive ones, with perhaps the same therapeutic results. This picture illustrates nearly every modern apparatus required to conduct hydrotherapy in a scientific manner, the details of which will be found in the following pages:

The fixtures comprise the following: 1. Hydratic control table for regulating the force and temperature of the ​water. 2. Rose spray or needle bath. 3. Attachment for rain or shower bath. 4. Sheet blanket and towel warmer. 5. Sitz bath with wave spray. 6. Tilting basin with mixing valve and shampoo. 7. Perineal douch and stool. 8. Massage table. 9. Full bath tub. 10 and 11, in the foreground, are the electric light, Turkish and Russian bath cabinets.

These baths are alway found the most agreeable to patients, and the variations of temperature have been classified as follows: Tepid bath from 85 degrees F. to 95 degrees F. Warm baths from 95 degrees F. to 100 degrees F. Hot baths from 100 degrees F. to 110 degrees F.

​In giving all baths we must take the normal temperature of the body as a standard, and any deviation from this temperature will have the depressive or stimulating reaction.

Tepid and warm baths are generally employed for simple cleanliness, and as the heat balance is nearly equal, they are often referred to as natural baths, which are used after other bathing processes.

Hot baths have a wide range of usefulness. They consume oxygen and have a marked influence upon metabolism. They eliminate carbon dioxide and increase oxidation.

These baths are used to maintain the normal temperature of the body in depressive diseases, as cholera, and to relieve congestion and inflammation of internal organs by drawing the blood pressure to the surface.

One of the seeming paradoxes in hydrotherapy is that hot or cold baths produce nearly the same physiologic results and if a pathological condition does not react to the hot bath, in many instances it will to the cold and vice-versa. The stimulating effect of the thermic irritants, when briefly applied, excites the peripheral sensory nerve terminals and thus produces stimulation. Cold baths have always been used by athletes as a hardening process and are applied, in present therapeutics, as a process of reducing temperature in fevers.

In the year 1861, Dr. Brand, of Stettin, wrote his first paper on cold baths as a process of reducing the temperature of fevers; although his method of giving baths has many modifications, this process of bathing has always maintained the name of "Brand bath." The technique of giving this bath, as modified by Dr. James Tyson, and used in the treatment of typhoid fever, at the hospital of the University of Pennsylvania, is as follows: The folding or portable bath tub is placed by the bedside of the patient, containing water at a temperature of about 70 degrees F. Compresses of ice water, or the ice cap is applied to the head, which is allowed to rest upon ​an inflated rubber cushion during the bath. The patient is gently lifted into the water and during the immersion which lasts from ten to fifteen minutes, the patient is constantly rubbed to maintain good circulation. At the end of the bath the patient is lifted into bed, where he is rubbed dry and placed between blankets. At the end of about fifteen minutes the patient will cease to shiver; the temperature is then taken and the patient allowed to rest for three hours, when the temperature is again taken, and if it is found to exceed 102.2 degrees F., or above, the bath is repeated. If the temperature is found 102 degrees F., or below, or over 101 degrees F., the bath is repeated in four hours from the last immersion. If below 101 degrees F., or above 100 degrees F., repeat the bath in five hours. If below 100 degrees F., repeat the bath in six hours. If, at any time the temperature should reach 102.2 degrees F., the baths are repeated every three hours, and as many as six or eight baths may be given during twenty-four hours. As many as 175 baths have been given during a course of treatment by Dr. Kinnicutt. While the principal object of the bath is to reduce and control the temperature, other bene fits are obtained of equal importance. The intellect becomes clear, and muscular twitching disappears, and there is a general tonic influence upon the nervous, circulatory and respiratory systems, producing sleep and a general tranquility of the bodily functions. There are several counter indications for cold baths. They should not be employed with too young or aged patients with weak vitality. After the cold bath there is always a reaction; the skin, which was shrunken and pale from the cold, in ten or fifteen minutes takes on a glow of red and warmth, showing that the blood bas again occupied the capillaries of the integument. This is the most important feature of the bath; it is through this reaction that all baths derive their greatest therapeutic value, and where patients fail to receive this reaction, cold baths should be duplicated with tepid or warm baths to develop the reaction power. Careful statistics have been recorded at different hospitals in this country relative to the value of baths in typhoid fever. Dr. ​Gilman Thompson states that the mortality from this disease has been reduced from 16 to 6 per cent. in New York hospitals since the introduction of the Brand bath. Dr. H. P. Loomis reports a reduction of 50 per cent. since the introduction of this bath, and, comparing the number of deaths in former years, it is estimated that fully one thousand lives have been saved each year in New York city alone from the use of these baths. There are many other substitutes for the Brand bath, principal of which are the graduated bath, cold pack and ice

rubbing. The graduated bath is obtained by placing the patient in a tub of water, at about the normal temperature of the body, which is gradually cooled until it reaches 80 or 90 degrees F., constantly rubbing the patient during the bath; while this bath is not as stimulating as the cold bath, it is a good substitute.

​The cold or cooling wet pack is another good substitute for the Brand bath, and has the advantage that it can be applied in localities remote from bathing equipments. The bed is covered with oil cloth, and the patient is wrapped in a sheet saturated with water at 70 degrees F.; as the sheet warms, a

new one is to be applied until, during the course of ten or fifteen minutes, five or six applications have been made. In preference to changing the sheets the crescent bath douch, or the gardener's sprinkling can is used to keep the surface cold.

The ice rub or ice ironing and ice poultices are also often substituted for the Brand bath. The ice rub is produced by a flat piece of ice, wrapped in gauze with which the body and limbs are thoroughly rubbed. The ice poultice is made by mixing finely pounded pieces of ice with either bran, corn meal or sawdust. These may be used either by immersing the entire body or applied locally as poultices.

For the universal use of the Turkish, or superheated air bath, we are, perhaps, indebted to David Urquhart, an English representative at the Court of Constantinople some sixty years ago, Mr. Urquhart had a sunstroke while living in that city, and his recovery was credited to the use of the superheated air baths, which for many years have been in vogue among the people of Turkey. On his return to England, he expounded the therapeutic value of these treatments for different Image missingStationary bath cabinet. diseases, with the results that they were promptly adopted in many cities in Europe and America, and today no hospital or sanitarium is considered completely equipped without this valuable curative agent. Its effects are refreshing, cleansing and decidedly stimulating to the circulation, and it is one of our very best means of eliminating toxic influences from our bodies.

The principal object of this bath is to produce profuse perspiration. The original Turkish bath consisted of placing the naked body in a room with dry hot air, at a temperature of 110 degrees F. to 130 degrees F., where he is allowed to remain for ten to fifteen minutes until free perspiration is ​established. He then enters another room with still higher temperature, from 150 degrees F. to 200 degrees F., for a few minutes until the diaphoretic action is very profuse; he is then placed upon a marble slab and given a thorough rubbing with the bare hands. This is followed with a soap shampoo with a loofah or Egyptian sponge. Of late years there have been many improvements in the technique of giving these baths and various bath cabinets have been invented, which produce the same therapeutic results, and are more agreeable to the patient. All these cabinets are arranged so the head may protrude, thus allowing the patient to breathe pure, fresh air, instead of the oppressive atmosphere of the Turkish bath room. The technique of giving these Turkish cabinet baths is as follows: The patient is supplied with a clean sheet with which to wrap his body, and placed in either a wood or oil cloth cabinet or bath chair (see cut) which can be heated from either a steam or hot air furnace, or an alcohol heater. After adjusting the cabinet about the patient, a towel should be wrapped around the patient's neck to retain the heat in the cabinet and a cold cloth applied about the head; allow the patient to drink all the water he may desire, which assists in producing the diaphoretic results and the eliminative effects of the bath. After the patient has remained in the cabinet from fifteen to thirty or more minutes he is then placed in the warm full bath, and thoroughly rubbed for a few minutes during this bath; he is now wrapped in a blanket and retires to the rest room, where the perspiration will continue for about a half hour or hour. During this time the patient will feel inclined to sleep, and the body will resume its normal condition; then the patient is allowed to take a final shower bath, with a soap shampoo, and rub his skin dry with a rough towel, and dress. The foregoing is the general procedure of the Turkish bath, as given at the present time, at most bathing institutions, and is one of the most important procedures in hydrotherapy. This bath has been largely succeeded, however, by the electric light bath, given in the foregoing chapter; the technique of the bath is just the same in both baths, only electric lights are ​used to produce the heat. This method is much more effective and also combines the therapeutic influence of light.

This bath is also adopted for its diaphoretic influence, and is conducted the same as the Turkish bath, only using steam instead of hot air for heating the cabinet. The temperature of this bath is considerable lower than the. Turkish bath, as the steam renders the higher temperature unbearable. The bather remains in this cabinet ten or twenty minutes, and the same procedure, and after treatment is carried out as with the Turkish bath.

This bath is also called the superheated air bath, and often referred to as the Betz bath, inasmuch as this gentleman has devised extensive apparatus for conducting the bath. This bath is really a combination of the Turkish and Russian baths. The superheated air is supplied by artificial means and the steam from the body of the bather. To conduct this bath the patient is wrapped in several thicknesses of blankets, and then placed in an "oven," where the temperature is from 200 degrees F. to 400 degrees F., and allowed to remain from twenty minutes to one-half hour, or longer, until free perspiration is established. He is then removed to the rest room, and allowed to steam for ten or twenty minutes, when the steaming blankets are removed, and the body wrapped in dry blankets; after a rest of about one hour, the same after treatment is conducted as in the foregoing baths. This is one of the most effectual baths in hydrotherapy, and is especially adopted in the treatment of inflammatory rheumatism, when the patient is helpless. These baths can also be conducted to local parts by the use of special cabinets, in the treatment of inflamed joints to obtund pain, etc.

Before adopting any of the superheated baths, the patient should be thoroughly examined to ascertain the condition of his heart, and during the bath the patient should be allowed all the cold water he desires. This increases the diaphoretic effects of the bath. The head should also be kept cool by the application of cold cloths, and the opening through which the head protrudes in the cabinet should also be tightly closed, by wrapping cloths around the neck to prevent the escape of heat or steam.

The question often arises: Which cabinet will be the best to install for an office or small sanitarium? My answer would be: The electric light cabinet, by all means, as it is the safest, cleanest and quickest in action of all bath cabinets, and avoids the danger of accidents from breaking pipes, etc. There are also well founded conclusions that the physical properties of the two agents light and heat far excel any other process in producing the diaphoretic effects desired, and the penetrating power of the two agents, which are so closely related in phys​ical properties to sunlight, penetrate the deeper structures and stimulate the metabolic processes and bodily activities.

Where another cabinet is added, a combination of heated air or steam is best for all medicated vapor baths, etc.

The Turkish, Russian, Electric light, and the Super-heated air blanket bath are among the most indispensable of bath equipments, in the treatment of many diseases. Their principal therapeutic effect is elimination through the cutaneous surface; they are, therefore, used in the treatment of alcohol and the drug habits, kidney diseases, rheumatism, joint and kindred affections, where the rapid elimination of toxic influence is desired.

The above substances are largely used at bathing institutes as an adjunct to hydrotherapy. Alcohol is usually employed as a finishing means. Only pure, grain alcohol should be used, either slightly diluted or pure. From two to four ounces will be sufficient for each bath. This is poured into the hand and applied to the different sections of the skin, until the entire body has been thoroughly covered. This method adds tone to the skin, improves circulation, and prevents the patient from taking cold after bathing.

Medicated vapor baths may be taken in the cabinet by the use of the vapor pan, a special apparatus to supply the medicated vapor, which is placed under the bath stool. The medicated solution is placed in the pan, and the heat underneath produces the vapor; by medicating any solution, the fumes given off in steam will produce its medical influence upon the body.

May be obtained by either vapor or in the tub by the following solution, which is known by several names: Sulpholine, liquid sulphur, Sulphol, etc.

Boil in an enamel or porcelain vessel until dissolved, and add from two to four or more ounces, to thirty gallons of

bath water for a tub bath, or dilute and use in vapor bath pan. This bath is hightly esteemed by many in the treatment of several skin diseases.

Another preparation used in sulphur baths is as follows:

​The above can be used to 30 gallons of bath water, or used as a vapor in cabinet baths.

Many bath establishments prefer to give sulphur baths with some one of the sulphides, the sulphide of sodium being preferable, owing to its solubility in water; this gives all the characteristic obnoxious aroma found around sulphur springs, and is used when they wish to imitate these fashionable resorts.

One ounce of Oleum pini sylvestris (pine needle oil) is placed in the vapor pan, with several ounces of water, and the patient is steamed for thirty minutes in the bath cabinet. The after treatment is the same as in other vapor baths; this is also useful in the treatment of many skin diseases. Acid, alkaline and other baths may also be given in the same way, but the two mentioned above are by far the most useful.

These baths are very highly esteemed in many parts of Europe, and have become quite popular in this country at a little health resort in Northwestern Indiana (Kramer, Ind.), ​where has been coined the names of Mudlava, Moor-Baths, etc. In the volcanic district of Italy the lava is used for this purpose under the name of Fango baths; the color of this substance is a grayish brown, and about the consistency of butter. The Fango is applied about the body, at a temperature approximating 110 degrees F., and a gentle massage of the body is given during and after the pack or bath, which lasts about one-half hour.

In several places in this country a good quality of blue clay, which has been thoroughly ground, is substituted for Fango, with nearly equal therapeutic results. These baths are especially beneficial in the treatment of stiff and painful joints, arthritis, sub acute rheumatism, sprains, neuritis and all injuries of the ankle, etc.

These baths are generally given in a tub, designed for the purpose (see bath equipment illustration), and may be either hot or cold, according to the effect desired. During the bath the rest of the body should be wrapped in blankets, and the feet also placed in a pail of warm water. Sitz baths are given for their local effect in the treatment of diseases of the abdominal and pelvic organs. Hot baths divert blood from these organs, and cold baths congest them. The hot Sitz bath has always been an important treatment in many menstrual disorders; amenorrhoea, dysmenorrhoea, neuralgia, and pain within the pelvic and abdominal cavities. Cold baths are given for their tonic effects, in the treatment of paralysis and intestinal atony, impotency and sexual debility of the male; also hemorrhagic states of the bladder, intestines and uterus, hemorrhoids, etc.

The shower or rain bath was first adopted by the Germans, and is one of the most convenient and cleansing of bathing methods. It has many advantages over the tub bath, inasmuch as it requires only about one-tenth the amount of water and ​the time required for bathing is much less. There is also economy in space for apparatus, and avoids the danger of communicating diseases in public places.

Shower baths are given with a view of imitating rain by a special device which hangs above the head. The spray can be regulated in force or temperature as desired. This bath has of late years been given in connection with the needle bath or douch, which consists of another device enveloping the body on the sides, whereby minute streams of water are thrown upon the body from all sides, giving the body a sensation as though needles were pricking it. The sharp stimulus these small streams produce upon the skin is very invigorating. The needle and shower bath can be operated independently, or hot and cold showers may be given as desired. A very stimulating effect is produced by alternating the hot and cold sprays; these two bath processes are generally used as an after bath, or as a cleansing process following the Electric light, Turkish and other cabinet baths, being the simplest and best way to tone the skin before leaving bathing establishments. The patient will withstand the prevailing temperature without taking cold.

These douches consist of a single stream of water, coming from a nozzle of a ¼ or ½ inch in diameter, at a distance of 8 to 10 feet from the patient, and may be regulated from intense cold to warm, as the treatment demands.

Cold douches are also used in chronic constipation and general auto-intoxication, insomnia, anæmia and other conditions, for their touie and reactive influences. Ilot and cold douches are also used, known as the Scotch douch. This douch is produced by two streams of water, one hot and the other cold, varying in temperature from 55 degrees F. to 110 degrees F. These douches are applied to the spine and posterior thorax and sides; also to the abdomen and lower extremities, but not to the anterior chest. The alternating of hot and cold is very invigorating and the tonic effects are used in many forms of paralysis and low forms of vitality.

These baths are given for their stimulating effect upon the body, and can be utilized for any purpose where these electric currents are indicated in general, and is a most excellent means for supplying the current to the entire body by placing one electrode at the head of the bath tub and the other at the foot or to stimulate the primea viae. The patient may sit in the center of the tub with the water up to or above the waist line and the electrode placed upon each side of the tub, and any style of portable battery may be used or a special apparatus devised as is illustrated in the accompanying diagram.

The salt rub or glow, as it is frequently called, is another means of producing a tonic effect to the skin, and is a substitute for sea bathing. This procedure is conducted in a tub of salt water, at a temperature of 104 degrees F. Five pounds of salt to forty gallons of water is the bath solution. During the bath the patient is constantly rubbed by the attendant, ​taking a small handful of salt and rubbing different parts of the body vigorously. After the body has been thoroughly covered by this process, the patient is generally given a final shower bath and rest.

The ice rub, or ironing, is also used to produce reaction of the skin and other organs. It is used largely in sunstroke. A flat piece of ice or a sack filled with ice is rubbed over the body for its reflex influence.

In conclusion, will say that Hydrotherapy is fast winning the confidence of the medical profession as a remedy, and water, like many other things provided in nature, is one of the natural means of restoring health. Dr. Winternitz, of Vienna, and Dr. Baruch, of New York, have been striving for years to make hydrotherapy the common property of the medical profession, and to this end have endeavored to extol its virtues as it justly merits and avert the empirics who are springing up in every direction as water-cure doctors. This is one of the adjuncts of medicine, which belongs to the physician and by adopting Hydrotherapy in connection with an office or Sanitarium practice, your efforts will be doubly rewarded, by the success you will obtain.

The following formula for the more commonly employed medicated baths used in diseases of the skin, etc., are as follows:

These baths are employed in pruritus urticaria and papular eczema.

Use one of these powders for 30 gallons of bath water, with one-half pound of starch employed in acute eczema ichthyosis psoriasis erythema and urticaria.

This solution is to be poured into 30 gallons of bath water, is used in pruritus parasitic skin diseases and syphilis. Great care should be taken in this bath and avoid the water from coming in contact with the eyes or mouth.

Tar baths are employed by rubbing the diseased patches with tar, and then removing the tar by the ordinary bath. This bath was much employed by the late Professor Hebra in psoriasis. Tan baths contain a handful of fresh tan bark in each bath. This has been recommended for purpura.

are generally obtained by adding one or two ounces of sulphurated potassa in forty gallons of water. The following, however, is the one used at this institution:

Mix and boil, stirring with a wooden rod until thoroughly dissolved. This gives off an odor of sulphurated hydrogen, which has the characteristic odor of most sulphur mineral waters. This solution is added to forty gallons of water for the bath.

This bath is a mixture of the above solution with blue clay and an addition of sufficient water to make the mud the consistency of plastering mortar. The patient is placed upon a massage table with elevated edges, and completely covered (except the head) with this mixture. During the bath the patient is constantly massaged by kneading and rotating the muscles from head to foot, and is very curative in its effects in many cases.

are given in a similar way to the mud baths, by completely covering the body with the sand. There is no place in the world in which sand baths are taken in the natural state so extensively as at Atlantic City. You can stroll along the "Board Walk" for miles and see people burying their anatomy in sand. Most of the bathers take these baths for pleasure, ​while others claim they derive much benefit from the practice. On a recent visit to this resort I counted no less than one hundred and fifty, fat and lean, rich and poor, awkward and indifferent, isolated in a place back of the "Board Walk" not over eight rods square.

If physicians were to accept the testimony of the proprietors of the various mineral water resorts, they would be led to believe that mineral water was a panacea for all ills. The fact of the matter is mineral waters are very much overestimated therapeutic agents. Although the water is the commercial drawing feature for many health resorts, the invalid who visits these places receives more benefit from the change of scene and the freedom of cares, business worry and the rigid dietetic and hygienic restrictions instituted at these watering places than they do from the medicinal properties of the water.

I am located only a few miles from Mt. Clemens, which has a world-wide reputation for its "wonder working water." I venture to say if the thousands of invalids who visit this city seeking for health, depended only upon drinking this water, many of them would be doomed to disappointment, but the use of water in connection with baths and massage eliminate many poisonous elements independent of any mineral the water may contain. I believe invalids can receive equally as effectual treatment with appropriate medication and the use of ordinary pure water.

The chemical and medicinal constituents of all mineral waters are well known, and if we decide they are the remedies required for an individual ease, apply the medication in its regular commercial form, or they can be given in the way of artificial mineral water if preferred.

Although this country supplies mineral waters equal in medicinal value to the imported waters, distance seems to lend enchantment and more value is placed on the foreign products. ​It has been stated that much of the imported water bottled and sold in this country as the genuine, is made from artificial salts, according to the following formulæ:

The following makes an excellent imitation:

Mix, dissolve and filter.

Triturate the ingredients, previously well dried, to a fine uniform powder. A solution of about sixteen grains of the above with six fluid ounces of water, represents an equal volume of Carlsbad water in its essential constituents.

Triturate the ingredients, previously well dried, to a fine uniform powder. A solution of about twenty-four grains of this preparation in six fluid ounces of water, represents an equal volume of Kissingen water in its essential constituents.

Triturate the ingredients, previously well dried, to a fine uniform powder. A solution of about 14 grains of this preparation, in six fluid ounces of water, represents an equal volume of Vichy water in its essential constituents.

Mix, dissolve and filter.

Mix, dissolve and filter.