\ R M f A :* .• '■ 1 LIBRARY OF CONGRESS. 1 m ; m ^ m I (Hl)ap. \\\ o\t> | 1 3fo. » vi ^^) & 3 $ I UNITED STATES OF AMERICA. 1 RESEARCHES INTO THE EFFECTS OF COLD WATER UPON THE HEALTHY BODY, TO ILLUSTRATE ITS ACTION IN DISEASE; IN A SERIES OF EXPERIMENTS PERFORMED BY THE AUTHOR UPON HIMSELF AND OTHERS. HOWARD F. JOHNSON, M.D. PHYSICIAN TO THE "FERNS" HYDROPATHIC ESTABLISHMENT, ALDERLEY EDGE, CHESHIRE. AreXrjQ dXoyog Trpd^ic, icai Xoyog dwpaKTOQ LONDON: LONGMAN, BROWN, GREEN & LONGMANS, PATERNOSTER ROW, MANCHESTER : WM. IRWIN, 53, OLDHAM STREET. 1850. ~RTrtfi sitting quietly in his study. 1. ' ... 66. ... 15.5 \ ,. . , . « , I 9 q ^~ 1 5 5 f ( " mn g > at hali-past one. 2.15 ... 72. ... 18. \ 2.45 ... 70. ... 15.5 J" 5. ... 88. ... 30. ...while out walking. 6. ... 63. ... 17. 71. ... 16.5 } sitting quietly in his study. Tea was taken at 7 p.m. From simple calculations made from these eighteen experiments, it is ascertained that the average number of pulsations of the heart per minute, is about 72.73, and that the average number of times the ribs rise and fall, constituting an inspiration and expiration, or in one word, a respiration, is 19.31 per minute. And as 72.73 arterial throbs are to 19.31 respiratory movements, so are 3.76 to one. This then, on very good grounds, 6 CORRELATION OF THE HEART AND LUNGS. [consult the chapter on the shallow bath] is considered the index or standard of harmonious relation between the action of the heart and lungs, these being the organs of cir- culation and respiration. But these conclusions are drawn from an impartial analysis of experiments, performed during all periods of the day, and under the most diversi- fied circumstances. Some of them, for example, were accomplished immediately after brisk walking exercise, and others after sitting perfectly still. It will be found that in all those that were conducted during or after exer- cise, the respiration is very frequent in proportion to the rapidity of the pulse. On the other hand, those exe- cuted during perfect repose of the body, evince just as regular a comparative acceleration of the pulse above that of the respiratory movements. As specimens of the former may be enumerated the fourth, seventh, eighth and fifteenth experiments. If an average estimate of the com- parative speed of the pulse and breathing were deduced from these four alone, it would be found to be very different from the results just detailed. The average respiration would be 29.72 instead of 19.31, discovering a difference of no less than 10.41. The average pulse would be 87.45 instead of 72.73, discovering a difference of 14.72, actually (that is in figures), greater than that in the case of respir- ation, but virtually much less. For as 1 : 3.76 :: 10.41 : 39.]$^ So that, 3.76 being the figure representing the normal average number of beats of the pulse corresponding to one respiration, 39.14 would, in the same proportion, indicate the number of pulsations balancing with 10.41 respiratory movements. But we have seen that in these four experiments, that were performed while the body was under the influence of walking exercise, although the pulse and respiration both manifested considerable increase in rapidity, that of the latter was the most marked. Whereas the latter experienced an additional 10.41 movements per minute, the former only gained 14.72 pulsations. CORRELATION OF THE HEART AND LUNGS. 7 On the other hand, if an estimate were formed of the aver- age rapidity of the pulse and respiration, from a consideration of those experiments only that were accomplished while the body was in a perfect state of rest, as, for instance, from the first, second, eleventh, and twelfth, a vastly diffe- rent effect would be the result. The average respiration would number 14.87 per minute, instead of 19.31, mani- festing a difference of diminution of 4.44. The beats of the pulse would be 62.75, instead of 72.73. Here also is a decrease, namely, of 10 in the whole number within two- hundredths. So that although, in this case, there is a depression of both pulse and respiration, there is com- paratively a considerably greater depression of the latter than of the former, since one respiration is equal in value to 3.76 beats of the pulse, and 4. 44 +3.76 = 16.69. The respiratory movements decreasing therefore to the extent 4.44, the pulse to correspond accurately with this diminu- tion would have fallen 16.69. The respiration consequently exhibits the largest fall. If the reader has carefully followed these statements and calculations, he will now distinctly understand, — firstly, that the numerical equilibrium between the pulsations of the heart, and the movements of respiration, is, in the nor- mal condition, as 3.76 of the former to one of the latter ; — - that this correct and healthy equipoise, however, is only maintained when there is a due amount of exercise taken, that is, when the body undergoes the salubrious change of rest and motion, — secondly, that exercise accelerates both pulse and respiration, but the latter more extensively than the former, — thirdly, that perfect repose of the body causes a diminution in the speed of both these functions, but of respiration in the most marked manner, — fourthly, and lastly, that the greater the number of respirations in a given time, or in proportion to the beats of the pulse, the more healthily are discharged the living actions, and of course, vice versa, the more dilatorily the office of respira- 8 EFFECTS OF SEDENTAEY PUESUTTS. tion is performed, the more speedily do these functions yield to the encroachments of disease. Now it will be readily understood how deleterious an influence the sedentary pursuits, so indispensable in the present state of society, can exercise in impeding the ac- tion of the lungs. First, the constrained stooping position necessary in either reading or writing, and mechanically cramping the lungs ; next, the absence of all active motion, causing debility of the muscles of respiration among other parts ; then the inhalation of a warm, and, however cau- tious the person may be to provide against it, not perfectly pure atmosphere, the former, as well as the latter condition, being highly injurious to the very susceptible pulmonary membrane ; all these circumstances, and many others, upon which it would be irrelevant here to enlarge, conspire to retard the respiratory movements, and to entail upon the individual the necessary destructive consequences. These soon loudly declare themselves in many forms, — in the shape of cerebral symptoms, as, confusion of ideas, giddi- ness, impaired memory, headache, and a legion of others, indicative of the flow of impure blood, that is, venous, un- oxygenated, undecarbonized, through the delicate structure of the brain, producing as venomous an effect as the inha- lation of so much carbonic acid gas; or in the shape of dys- peptic symptoms, as flatulence, heartburn, pain at the pit of the stomach, constipation, &c. &c, generated by the same undecarbonized blood flowing through the textures of the stomach and bowels, or in the shape of uterine symptoms, which appear to become more frequent almost day by day, and hour by hour, or, lastly, in the very fatal shape of consumption. In the year 1838, according to the Registrar's Annual Report of Births, Deaths, and Marri- ages, out of the total deaths in England and Wales, no less than 27.5 per cent, were attributed to disease of the lungs, and out of these, consumption slew a no smaller number than 59,025. To what can this frightful mortality be more CAUSING CONSUMPTION AND OBESITY. 9 justly ascribed, in part at least, than to the unwholesome sedentary habits of the present day ? In a close, ill-venti- lated, heated, atmosphere, debarred from the natural stimulus of cool, pure air, and healthful exercise, mechani- cally cramped in their movements by a forced and unnatu- ral position, is it to be wondered at that the lungs become a fertile soil for the scrofulous seeds of consumption to take root, and flourish ? The same unwholesome, confined pursuits, by the con- straint they put on the respiration, give rise to the develop- ment of an inordinate amount of fat. This substance, so unsightly to the physiologist, because so hurtful to the system, when existing in superfluous abundance, consists essentially of two elementary ingredients, carbon and hy- drogen, and it will easily be made manifest to the reader, how retardation of the respiratory process causes its super- abundant deposition in the tissues. The air we take into the lungs in respiration is composed of oxygen and nitrogen. The air that is evolved from the lungs consists of nitrogen, car- bonic acid gas, and aqueous vapor. The nitrogen comes in andgoes out precisely in the same condition, unchanged. It is united with the oxygen merely for the purpose of dilution, for pure unmixed oxygen is too irritating for the lining membrane of the pulmonary air-cells, and on that account is itself as poisonous to breathe as any atmosphere alto- gether deprived of this vital gas. Carbonic acid is a chemical combination, in definite proportions, of carbon and oxygen. Aqueous vapor, or vaporified water is also a definite chemical compound of oxygen, but hydrogen, not carbon, is its other ingredient. Oxygen, therefore, enters the lungs simple, uncombined (for it is not chemically united, but merely mechanically mixed with the nitrogen), and it returns, combined chemically with two other sub- stances, viz., carbon to form carbonic acid, and hydrogen to form water or aqueous vapor. > so to speak, or acts wrongly, without there being any real, bona-fide, substantial disease to account for it. For example, a lady suffers very much from palpita- tion of the heart, but there being no stethoscopic signs of disease in that organ, and there being none of those colla- teral symptoms, generally supposed to be indicative of organic disease of the heart, as spitting of blood, difficulty of breathing, dropsy of the chest, abdomen, or limbs, &c, &c, she is confidently assured that she has no real heart disease whatever, and that she will probably soon be well. Or a gentleman is afflicted with dyspeptic symptoms, flat- ulence, constipation, heart-burn, water-brash, caprice of appetite, foul tongue, &c, &c. A careful and minute examination is instituted both by the stethoscope and manipulation into all his viscera thoracic and abdominal. The heart and lungs are found intact, the liver does not protrude below the ribs nor above the rib that should mark its upper boundary, there is no tenderness over the stomach, bowels, or bladder, the spleen is in its right place, the kid- neys entire, no hypertrophy, induration or tumor is 16 FUNCTIONAL AND ORGANIC DISEASE. discovered, in brief no abnormality can be detected, and the patient receives with gratified ears the pleasing intelli- gence that he has no disease, that is, no real disease about him, and that there is nothing to prevent his speedy recovery. This then is the distinction usually drawn between func- tional and organic disease. But the author has no hesitation whatever in saying, that he does not believe in the existence of such functional disease. He does not even believe such a thing possible as that the function of an organ should be ill-accomplished without the presence of actual organic disease. If so, why does not functional disease get well ? It is true that it does sometimes, but it is equally true that it sometimes does not. And organic disease also gets well sometimes. Well, but you will say, where is the disease ? Shew it us, and we will acknowlege it, but our senses take no cognizance of it. I grant that, replies the author. I know the disease present is inappre- ciable to the gross perception of the senses, but that is no more a reason that it should not be there, than that ani- malcula did not exist in water before they were discovered by the microscope ? Is it possible to conceive how a pen- dulum, once set right, should deviate from its course with- out a physical cause ? Is it possible to conceive how a steam engine, once in full play, should cease, or alter its motion, without a physical, mechanical cause ? In the same way it is equally, or more impossible, according to the author's conviction, to conceive how, in so elaborate and perfect a piece of machinery as the human system, a single organ can discharge its function imperfectly without there being something physically, mechanically wrong. From how many trivial faults, and inappreciable to all eyes but those of a watch-maker may a watch go wrong ? But we never hear a watch-maker talk of functional disturbance of a watch. It would be too ridiculous. Yet it is equally ridiculous to imagine that functional derangement can FUNCTIONAL AND ORGANIC DISEASE. 17 occur in the animal economy without the existence of organic disease. It may occasionally be difficult to detail its whereabout, but it is always there. Take, for example, once more, a palpitating heart. Analyse its muscular sub- stance, which forms nearly its entire bulk, in every manner possible, physically, chemically, microscopically, and you will probably discover no disease. Carefully dissect its blood-vessels, and rigidly inspect both themselves and their contents. Still, probably, no fault will appear. But there still remains a most important subject for investiga- tion, the nerves of the heart. These, because they are the least understood of all, require the most scrupulous attention. And here, although parts before perhaps com- pletely overlooked, will the disease, the real disease, in all probability be located: for the heart is surrounded by an enormous quantity of most delicate nervous tissue, whose duty it is to regulate its motion, as the pendulum of a clock regulates the movements of its hands. What the pre- cise nature of the disease may be, of course must depend upon circumstances. A cardiac nerve may be congested justin the same manner as the brain may be congested. It may be too well supplied with blood or too ill supplied. In fact, any thing may be the matter with it, as anything may be the matter with the brain, only of course on a compara- tively limited scale, so limited indeed as to escape notice. The author has at this moment a lady under his treat- ment w r ho suffers from most unpleasant sensations beneath the left breast, but deeply seated. She has been an inva- lid many years with an uterine complaint. And although she in consequence experiences many aches, pains, and morbid feelings in different parts of the body, all of them seem eventually to terminate in some, as beforementioned, unpleasant sensation on the left side of the chest. "When she first came under his care, she had suffered so much in this respect that she was convinced, in contradiction to what all her medical advisers had told her, that she laboured D 18 FUNCTIONAL AND ORGANIC DISEASE. under disease of the heart. The author examined the organ with the stethoscope, and then after a careful analy- sis of the symptoms, told his patient, that she and her pre- vious medical attendants were both right. He then explained to her that she had not what they called disease of the heart, viz., palpable, structural change, recognisable by the naked eye, but that the nervous ganglia and plexus every where investing the organ, and presiding over its function were certainly extensively affected, so that she was perfectly correct if not in word, (although even that is doubtful) at least in idea. And so of all other so-called functional diseases the author contends that there is no such thing, that it is a mis-nomer, that all functional disease is the result of organic disease, although this may be so concealed as to elude the gross evidence of the senses. Considering therefore that the division of diseases into organic and functional, to be altogether arbitrary, false, and absurd, and that all disease is organic, his duty is simpli- fied. He has merely to shew the effect of hydropathy through its influence upon the process of respiration in dissipating organic chronic disease, in other words, chronic disease generally. Chronic disease alone is mentioned because cases of acute disease so rarely fall beneath the notice of the hydropathic physician, that it is not worth while to bring it into discus- sion in this place. The author has now to propound a notion that may at first sight appear to the reader both novel and strange. He looks upon all chronic disease, of whatever class or denomination, and of however contrary natures, as consis- ting essentially of one of the, three following conditions, namely, the existence of too much blood, or congestion of the part affected, of too little blood or anuaecia of that part, or of the supply of blood of an impure character to that part. He considers that all diseases, whether of nerves, EXAMPLES OF DISEASES OF THE BLOOD. 19 blood-vessels, skin, internal viscera, muscles, or bones, are all to be referred to one of these three conditions. The part diseased is over-supplied with blood, is deficient in that vital fluid, or receives to nourish it, blood whose bad qualities render it incapable of performing that office, or even affect it poisonously. The nature of the work forbids explanation upon this point, or it would be easy to prove the author's position in every individual malady. He must therefore be contented to request the lay reader to be satisfied with what he has already said upon the sub- ject. And, for the medical reader, he will merely cite a few examples, without explanation, from the most com- mon diseases. Apoplexy depends generally more or less / upon congestion of the brain ; syncope upon anaeucia of X the brain ; dyspepsia upon congestion of the liver and 3 stomach ; constipation upon debility, that is, aneucia of J the muscular coat of the bowels ; Bright's disease upon . t/ congestion of the kidney ; nervousness upon congestion, sometimes, but generally upon anaeucia of the whole ner- vous system ; jaundice upon obstruction from congestion u of the liver; gout upon a poisonous superabundance of V uric acid in the blood ; rickets, and a whole host of other strumous affections upon general deficiency of blood ; 1 scrofulous tubercle, and cancerous deposit upon a veno- '0 mous property in the blood. In fact, the only kind of disease that would offer any prima facie difficulty to the reception of this view would be spasmodic diseases, such as St. Vitus' dance, epileptic and hysterical fits, asthma, hooping cough, and others. And here the author would enquire if any of his readers, medical or lay, is aware to what source these diseases can be traced. Hitherto their origin has been involved, and still is involved, in the profoundest mystery. Now, in his own mind, he entertains not the slightest doubt that some fault in their nutrition is at the bottom of the mischief; that some, probably very trivial, congestion, or lack of sufficient blood, or supply of impure blood at some part of the nervous system (whether brain, 20 EFFECT OF HYDROPATHY ON CONGESTION. spinal cord, or single nerve, varies of course according to circumstances), is the real cause of the disease, at all events, we know that congestion of the brain, that anseucia of the brain, and that a poison circulating through the brain, after either inhalation or imbibation, will induce a fit of convul- sions. That we see daily. With perfect fairness, therefore, spasmodic diseases also may be referred to one of the three states before mentioned for their origin ; and neuralgic pain, or tic, is certainly at- tributable to the same causes. The question, therefore, now to be decided is this ; is hydropathy, through its influence upon the process of re- spiration, capable of overcoming congestion, of furnishing more blood in a deficiency, and of remedying a vitiated state of that fluid ? Let these matters be discussed seria- tim. To begin with congestion, what is the meaning of this term ? Congestion, implies the presence of an ab- normally large amount of blood ; its immediate cause is to be found in the blood-vessels of the part affected. For some reason or other their contractile coats are ill nou- rished ; they become weak in consequence, and lose their natural elasticity : distension follows, caused by the pres- sure of the blood within being now unresisted by the vas- cular walls ; this bulging, of course, permits the ingress of more blood than could before be contained in the same space ; besides this, the current of blood is deprived of that onward impetus, which was before bestowed upon it by the constant pressure of the elastic coats. Its course, there- fore, is virtually impeded, so that, in addition to there being more fluid admitted into the vessels, there is also a tendency to stagnation. And all this misery arises imme- diately from the fact of the vascular coats being weakened and losing their elasticity from a scanty supply of nourish- ment, that is, of nutrient blood. The only method, there- fore, of curing this congestion effectually and permanently, is to bring an abundant supply of good blood to restore their vigour and elasticity to the blood-vessels. EFFECT OF HYDROPATHY ON CONGESTION. 21 To the superficial reasoner, or indeed to any one not conversant with the subject, it may, at first sight, appear inconsistent, when there is distinct evidence of the exist- ence of too much blood in any individual part, to hold out as a means of curing such superabundance the further ad- dition of blood. But even at this superficial view it can be no more heterodox treatment, than the adoption of a plan put in force nearly every day by nearly every person, namely, the abstraction of blood, for local congestion, in an invalid whose whole system is already drained of that fluid. Yet this practice, the application of leeches, or of the cupping-glass, to a sick man for a local cause, whose general system cannot spare a single drop, is one of which not a soul for an instant doubts the propriety. But, in point of fact, without having recourse to analogy, in refer- ence to the first subject, viz. the supply of additional blood to the body, to cure a congestion, that is, a local super- abundance, a full comprehension of the modus operandi is insured by the above-mentioned theory, and that theory is well supported by experience. Now exaltation of the process of respiration, by what- ever means, effects this additional supply of blood ; and hydropathy exalts that function, increasing, as it does, both the rapidity and depth of breathing. The more frequently a man breathes, the more atmospheric oxygen is inhaled, and passes into the blood, through the lining membrane of the air-cells. As before explained, the more oxygen that is conveyed to the periphery, or rather to the whole sub- stance of the body in the blood, the more actively go on those chemical changes in the tissues, which are prepara- tory to the expulsion of worn out, effoete materials, and which give rise to the evolution of animal heat. The more energetically these chemical decompositions take place, of course the more abundantly is old tissue cast off, and ulti- mately expelled from the body, and the more speedy the consequent desire for a new supply of fresh tissue. This 22 STATE OF THE BLOOD. can only be contributed through the digestive organs, so that thus an appetite is created. But the appetite which probably was altogether absent, or at least ailing and ca- pricious before, is no sooner felt, than gratified. And in this way new materials enter copiously into the body, ca- pable of becoming manufactured by an elaborate machinery into good nourishing blood. A part of this of course finds its way to the debilitated coats of blood-vessels, the seat of congestion. The vascular tunics, in consequence, be- come re-invigorated, and regain their elasticity ; on account of recovering this property, they contract and close upon their stagnating contents. The slow current is urged for- ward, the congestion gradually disappears, and health is re-established. We have now seen the effect of exalted respiration in re- moving ordinary congestive diseases. But there is another kind of congestion, a sort of acute, inflammatory conges- tion. The first comes under the denomination of passive, the latter of active, congestion. As this affection is more nearly allied to acute, than to chronic disease, no further notice of it will be here admissible, as chronic maladies alone are the subject of the present discussion. The next cause of chronic disease, and a most universal one it is, is, according to the preceding classification, a de- ficiency of blood, or which is the same thing, an impover- ished or watery state of that fluid, producing, as it does, of course, a deficiency of its essential ingredients. The most important of these ingredients are the red globules, fibrine, or, as it is called under certain circumstances, plastic lymph, and albumen, that substance which, present in an eggj is called the white-of-egg. The red globules discharge the office of conveying oxygen from the air-cells of the lungs, where it enters, to the tissues spread over the entire body. They may be looked upon as so many minute carts or waggons, perpetually running between the lungs and tissues, laden on one journey with oxygen, and on the CONSTITUENTS OF THE BLOOD. 23 other with carbonic acid gas, — the oxygen to help to pull down used-up structures, the carbonic acid, the result of the union of the oxygen with the worn out material, to be expelled into the air through the pulmonary membrane. The colouring matter of the blood is located in these little spheres. The fibrine, or coagulable lymph, is that part of the blood which, when a person is phlebotomized, and the extracted fluid allowed to stand in an open vessel, forms the floating coagulum or clot. It is tinged, of course, by the mechani- cal adherence of some red particles to its substance. It is out of the fibrine of the blood that muscles and many other solid parts of the body are manufactured. Its importance, therefore, in contributing to the integrity of the vital fluid can no more be questioned than that of the globular red particles. After the fibrine has spontaneously separated from the rest of the liquid in an open vessel containing blood, if the liquid residue be submitted to the application of heat, another coagulum will be formed. This is albumen, and of it many parts of the frame, especially the cerebro-spinal system, and ligamentous tissues, are fabricated. Now when these essential constituents of the blood are deficient, just as much as when the whole quantity of that fluid is abnormally small, is the invalid said to labour under anaemia. Does accelerated respiration, brought about as it is by hydropathic appliances, tend to restore these in- gredients to their normal quantity ? Most assuredly, for has it not been shewn that increased breathing both im- parts, when absent, and improves, when indifferent, the appetite, and consequent ingestion of food ? And, since they depend for their existence upon the matters taken into the stomach, must it not inevitably follow that the more food received into the body, cceteris paribus, there must be a corresponding increase in the essential ingre- dients of the blood ? And in this way in truth is anaemia 24 DISEASES FROM IMPURITY OF THE BLOOD. both when consisting of a really diminished quantity of blood, and when of an impoverished condition of that fluid, permanently cured. It only remains now to speak of those diseases that arise from an impure or poisonous state of the blood. Gout may be taken as a specimen of disease of this pathological condition. The nature of gout essentially is the existence in the blood of an acid in great abundance, called uric acid. If this abnormal substance were to continue for any length of period increasing in the blood, it would unquestionably impart such a poisonous property to that vital fluid, as to become fatal to life. Nature, therefore, endeavours to throw it out of the system through the medium of the different articulations. This remedial effort constitutes a fit of the gout, and the joint most usually selected for this purpose is that which unites the great toe to the bone of the foot immediately above. Now it necessarily follows, that however much an acute attack may be ameliorated by- remedial measures, the only way to cure gout, to eradicate it from the system, is to destroy the uric acid in the blood, and having done so, to prevent its re-formation, in other words, to purify the blood and maintain it in a state of purity. And what so capable of doing this both effectually and permanently, as the invigoration of that process which imports oxygen into the system, which aerates the blood, which regulates the chemical action in the tissues, upon which, in fact, depends the due performance of all the vital functions? Increased power, therefore, of the respiratory process, beyond a doubt, is the thing calculated not only to eradicate the poison of gout, but to cure all the other maladies arising from the presence of impurities in the blood. Thus, then, it appears that hydropathy, through the in- fluence it exerts upon the lungs, is capable of producing a beneficial effect, at least in all chronic diseases. And such a point of fact the author firmly believes to be the case. THE ORIGIN OF DISEASE. 25 Even in those affections which are no more curable by hy- dropathy than by any other system of remedial agency, he certainly thinks that patients will leave a cold water estab- lishment in a fundamentally better state of health than they enjoyed on their entry therein. Although the local dis- ease, perhaps some tumor, it may be even cancerous, or scrofulous, be not removed, nor at all likely to be removed, still so much benefit is usually conferred upon the general health, in the shape of increased vigor, mental and physical, improved appetite, and rectified secretions,, that the pa- tient does not repent his hydropathic sojourn. The author has now cursorily described a few of the happy results that follow improvement in the process of respiration. Such improvement is proved in the ensuing experiments to attend upon the various hydropathic appli- cations. In the last paragraph but one, the author has striven to shew how hydropathy may be beneficial in nearly all chronic diseases, of however dissimilar pathological charac- ter, through its influence upon the respiration. Lest it should appear to some sceptically inclined that there is a little over-straining in this matter, he would beg permission to support this argument by the brief introduction of another. He would premise, however, that among those thoroughly conversant with the subject, the fact is un- questioned. Let the reader kindly picture to himself, if possible in this civilized world of ours, a man in perfect health, at all events in the enjoyment of so much as is commonly called good health. It is to be supposed that every one is blessed with this happy condition at some period of his life, how- ever early, with the exception of a few miserable crea- tures that are born diseased. Now, when a person is once healthy, how does he become unhealthy ? What is it that permits the ingress of disease ? Be it remembered that chronic disease alone is to be taken into account. When, E 26 DIVISION OF ORGANS. then, does this disease find admittance into the system ? What is the origin of dyspepsia ? In what manner does congestion of the brain commence ? How does the kid- ney degenerate into that peculiar state christened after Dr. Bright ? Why do the bowels cease to perform their func- tion ? Do all these evils spring up of themselves, without any other recognizable cause ? Certainly not. It is im- possible it should be so. When the human machinery is in perfect order, it is quite impossible to understand how it should become disarranged without some independent external agency. The seeds of consumption will grow spontaneously, when placed in a fit receptacle, but they must first be sown. Let us now inquire into those matters which are capable of exerting an influence, beneficial or deleterious, upon the animal economy from without, that is independent of the animal economy. It will be found that certain organs are exposed to external impressions, and that certain others are not so, (except of course secondarily through the medium of the first). Those organs that are subject to external impressions may be enumerated as follows : 1. The gastro-intestinal mucous membrane, consisting of the mouth, esophagus, stomach, small and large bowels. 2, The mucous membrane of the air-passages containing the larynx, the trachea or windpipe, the bronchial tubes, and the air-cells of the lungs. 3. The cutaneous membrane, or as it may be called, the external mucous membrane. 4. The brain. 5. The organs of propagation. The viscera, that may be said to be not primarily susceptible to external in- fluence are, 1. The heart. 2. The Liver. 3. The kid- neys. 4. The spleen. 5. The pancreas. 6. The bladder. The first series of organs are very much under our own control. The second are totally independent of us. The consequence is, that we can and do abuse the former very frequently in a straightforward manner. The latter suffer only indirectly. And the author has not the slightest ti- THE DIGESTIVE MUCOUS MEMBRANE. 2/ midity in avowing that disease first enters the body through some gate found open in one or more of the first five organs — that internal disease of whatever kind, and where- ever located is invariably the result of some morbid im- pression made upon one or more of these five organs from without. Nor are even hereditary affections, or any spe- cific maladies, as miasmatic or contagious disorders, any exception to this general, nay, universal principle. The mode in which such morbid impressions may be, and are daily made upon the system by the medium of the organs before-mentioned, as susceptible of external influ- ences, is easily enough understood. Let us begin with the one placed first on the list, namely the gastro-intestinal mucous membrane. This long tract of surface lining the interior of the mouth, throat, esophagus or gullet, and sto- mach, the three small bowels, viz. the duodenum, ilium, and jejunum, and the three large bowels, viz. the ccecum, colon, and rectum carries on the digestive department of the animal functions. In the mouth the food is received and masticated. In the stomach it is tristurated with the aid of the gastric juice, till it is converted into a grey pulpy mass, called chyle. In the duodenum this mass comes in contact with the secretion of the liver, the bile, which separates it into two portions, the nutritious chyle, and the non -nutritious residue. Along the whole length of the small bowels are ranged a number of microscopically minute hollow organs, called lacteals, through whose fine, attenuated investing membrane this chyle penetrates to be carried by vessels, called lymphatics or absorbents, into the veins. It is then carried by the current of the blood, venous blood of course, to the lungs, where it is aerated, and rendered fit for the fabrication of human tissue. The innutritious residue passes along the small bowels into the large ones. It there mixes with certain local secretions, and the mixture constitutes what is finally expelled. From this it plainly appears that anything taken into the 28 THE DIGESTIVE MUCOUS MEMBEANE. mouth of an irritating nature is capable of irritating all these parts engaged in the process of digestion, and di- rectly and deleteriously affecting the correct discharge of their functions. In this way unwholesome articles of food, as well as food in too hot or too cold a state, also irregu- larity in taking sustenance, sometimes taking too much, at other times going too long without any, for the gastro- intestinal mucous membrane suffers as much from the re- ception of too much or too little food, as from such as is of an unwholesome character — in this way, to repeat, all these unnatural inconsistencies produce their injurious effect. And in this way is one gate opened for the admis- sion of disease. When once entered, his devastations may be modified in character and extent according to various casualties. And the only way to drive him out is through the same road by which he entered ; namely, it is only by instituting dietetic regimen, that he can be expelled, and afterwards kept at a distance. Now, there is no one thing upon which hydropathy insists more unflinchingly than upon dietetic regimen. Let it be borne in mind, nevertheless, that it is not in- tended to assert that, when disease has once got a firm hold upon several internal viscera, although it effected its en- trance into the system through a dietetic error, or rather a series of dietetic errors, it can be at once and effectually expelled by abandoning those inconsistencies merely. Otherwise disease arising from this source might be cured by the individual leaving his pursuits and making a sojourn, say at a farm-house of primitive dietetic simplicity, with- out having recourse at all to hydropathic or non-hydro- pathic physician. But this has been proved to be insuffi- cient. Mere correction of diet is not enough. What the author, therefore, wishes the reader to understand is this, that unless the aid of dietetic regimen be sought, or in other words, if the cause of the malady be allowed to con- tinue in full force, all other treatment he may adopt will THE AERIAL MUCOUS MEMBRANE. 29 fall to the ground useless. Let these remarks also be well remembered, when speaking of diseases admitted into the body through the other organs exposed to external influences. The mucous membrane of the air passages is the gate, by which the obnoxious properties of impure air are im- bibed into the system. It is there that various poisonous gases find admission. The most common of these is car- bonic acid, which is the principal ingredient of the vapor exhaled from the lungs. Hence its abundant presence in places of public amusement, balls, concerts, &c. It is questionable however whether this gas, when present only in such quantity as not to render the air irrespirable, really enters the blood, or only acts injuriously by excluding oxygen. Pure carbonic acid gas cannot be inspired as it always causes the spasmodic closure of the top of the windpipe. Through this pulmonary mucous membrane then the obnoxious effects of too warm an air, an impure air, &c. are manifested in the economy. And any maladies arising from the inhalation of an impure atmosphere can only be thoroughly extirpated by the substitution of a pure one. For example, if a person living in a marshy, miasmatic dis- trict, be afflicted with ague, the first prescription is to remove the patient into a dry atmosphere. Without this precaution the chances of success are but small. Now, as the hydropathist rigidly enjoins regimen in diet, so also does he maintain the absolute necessity of pure air in the vicinity of his establishment. The third organ on the list, as susceptible of external influences, is the skin. This membrane is the most extensive, one of the most important, and the most complicated organ in the body. Nevertheless it is the most easily maintained in the proper discharge of its various offices, and no doubt, therefore, the most religiously neglected. The skin occupies so momentous a position in connexion with the 30 THE ANATOMY OF THE SKIN. subject of hydropathy, that the author entreats permission to say a few words concerning its anatomy and physiology, even though it should appear a digression. A man of moderate height and bulk presents a surface of two thousand, five hundred square inches. This of course therefore is the exact admeasurement of the skin. Now with regard to its anatomical construction. However simple this membrane may appear by looking at it only with a bird's-eye-view, very many diversified elements enter into its composition. The most important of these, or at all events those which alone require mentioning here, are: — 1. The papillae, which form the residence of the sense of touch. 2. The sebacious follicles, placed there for the object of lubricating the surface. 3. The perspi- ratory apparatus. The papillae are a number of minute pyramidal bodies, whose apices are perpendicular to the surface. If any of them be exposed by the removal of their protective covering, the cuticle, as by a blister or burn, acute pain is experienced. They are most abundant where the sense of touch is most acute. The pulpy surface of the extremity of the finger is therefore abundantly sup- plied with them. The common corn is nothing more than the hypertrophy of one of these conical papillae, covered over with a thick layer of cuticle. " Cutting a corn " dimishes the pressure upon the tender spot caused by the boot, or anything else. Superficial neuralgic, or tic pains may be all expressed by a fitful irritability of these neglected and ill-used organs. Ill-used, be it repeated ; because this unnatural impres- sionability is not owing to chance, nor to the season, nor to the calumniated climate of England, but simply to the wilful neglect of those who suffer. If the victims of these aches and pains would only pay half the attention to their own health that they do to their cash accounts, or idle amusements, their penance would be unpaid, their lumba- gos, rheumatisms, and tics unfelt. EXPERIMENTS ON THE PERSPIRATION. 31 The sebaceous follicles are minute crypts or blind alleys scattered all over the skin, whose office it is to secrete an oleaginous fluid for the sake of maintaining the cuticle or external integument in a constantly moist and plia- ble condition. It is inflammation supervening upon obstruc- tion of these follicles that gives rise to that crop of pimples frequently so flourishing about the age of adolescence. The perspiratory apparatus differs from the sebacious in secreting its fluid, for which there is no further use in the animal economy. The organs devoted to this object are a series of small glands pervading the whole superficies of the body, but more abundant beneath the arms than else- where, and made up of a convoluted tube terminating in a straight one, which discharges its contents by an open mouth on the surface of the skin like an ordinary sewer. A philosopher, called Sanctorius, weighed himself, his food, and his excretions every day for thirty years, with the intention of ascertaining how much of the waste of the body passed off by the lungs, kidneys, bowels, and skin. He arrived at the conclusion that five-eighths of all dis- charged escaped through the skin. Another philosopher of the name of Seguin, with the same object in view, performed the following ingenious experiment. He procured a perfectly air-tight bag, with which he completetly invested himself, leaving a hole to breathe through. The edges of this opening were glued to his lips, so that no perspiration could escape. By care- fully weighing himself at the beginning of the experiment, and twice at the end, viz., in, and out of the bag, he ascertained first how much in weight he lost by pulmonary exhalation, and secondly how much by cutaneous secretion. His body lost on the average through both channels together eighteen grains per minute, eleven of which permeated the skin, while seven only escaped by the lungs. Eleven grains per minute are equal to thirty-three ounces per day. And it must be remembered that the whole of this loss was 32 RESULTS OF SUPPRESSED PERSPIRATION. by insensible perspiration, of which one takes no cognizance. Now if it be natural for a man to eat, say a pound and a half of food per diem, and for the skin to excrete in the same time thirty-three ounces of fluid from the body, it is as important, consistently with health, for the whole of that fluid to be so discharged, as it is for the whole of that food to be taken. It is perfectly true that if this, the natural passage for certain portions of the debris of the body, be impervious, as it too frequently is, that the kid- neys will endeavour to compensate for the fault in the skin by doing double duty. But what is the consequence ? The kidneys of course suffer from excess of work, and the skin from inactivity becomes still more diseased than it was before. Dr. Osborne,* a gentleman who has made kidney disease his peculiar study, declares that twenty-two cases out of thirty-six of that affection were immediately attri- butable to suppressed perspiration. And Dr. Christison, in his work on granular degeneration of the kidney, confirms the opinion by saying that, where his patients did not ascribe the cause of their disease to suppressed perspira- tion, they gave no cause at all. Who does not know that inflammation of the lungs, bowels, and brain, gout, rheuma- tism, and every acute disease under the sun, occasionally if not generally proceed from the same cause ? Is it not therefore truly marvellous, acquainted as we are with these facts, and a clear knowledge of the necessary baneful results of their neglect staring us full in the face, that we should suffer this most vital organ to dry up like parchment, to fall into such ruinous decay as to be unfitted for its office ? Thirty-three ounces (or rather more than two pounds) of a fluid containing solid matter in solution passing ^ut of the body through the skin daily, it follows as a matter of certainty that some portion must become concrete, and # Osborne on Dropsies ; second edition, London, 1837. RESULTS OF SUPPRESSED PERSPIRATION. 33 adhere to the surface. To obviate any evil consequence that might arise therefore this should of course be washed away. But if no such ablution be performed, the chan- nels both of the sebaceous follicles, and the perspiratory glands become obstructed, the former causing the skin to become harsh, dry and brittle, and the latter giving rise to the already-mentioned injurious results of suppressed per- spiration. Two of the elements of this complex structure being deleteriously affected, its other component parts soon participate in the mischief. For example the papillary or sensitive layer becomes acutely irritable, and neuralgic pains follow. There is also a wonderfully close sympathy between the skin and the digestive viscera, so that the chorus is soon swelled by the discordant voice and manifold horrors of dyspepsia. General ill health, malaise, debility, languor, now reign triumphant. The patient becomes very delicate, and susceptible of cold. More flannels are put on the body, more blankets on the bed, more fuel on the fire. He trembles when he asks which way the wind is, shudders at the mention of cold water, and in one word an affection that could have been washed away with a hand- ful of water is about to degenerate into a serious disease. And yet how many wash their skin once a day ? How many once a week? How many once a month ? One more important function of the skin, and one not to be passed over in silence, is the regulation of the animal heat. It is very well established that however much the temperature of the surrounding atmosphere may vary, that of the human body remains within a degree or two invar- iably the same. In our own fluctuating climate this is ex- tremely important. For otherwise our bodies would one day be at summer heat, another at winter heat, and so on, a changeableness clearly incompatible with human life. Were it not so too, we should be necessitated to remain for ever in the climate of our birth. But on account of this innate power of maintaining undisturbed the same, and F 34 THE SKIN THE REGULATOR OF ANIMAL HEAT. normal temperature of the interior of the body, we can shift about from east to west, from north to south, with im- punity. Captain Ross in his journey to the polar regions endured an amount of cold capable of freezing mercury, namely, forty degrees below zero. Sir Joseph Banks re- mained for a short time in a room whose temperature was raised fifty degrees above the point where water boils, namely, two hundred and sixty two. In this experiment either Sir Joseph or one of his companions wore a pair of spectacles, which became so hot, that the metal burnt his skin, and he was obliged to remove them. And yet neither Captain Ross nor Sir Joseph Banks experienced the slight- est harm. Why ? Because the heat of their internal vis- cera was unaffected. If it had been possible for the surrounding atmosphere to influence or alter it in any way, Captain Ross's blood would have become converted into sticks of red ice, and that of Sir J. Banks would have co- agulated like a boiled egg. The power of thus controlling and limiting the tempera- ture of the body is vested in the skin. Every portion of fluid secreted through its pores in its passage from the fluid to the vaporous form must appropriate a large quan- tity of heat, thereby rendering what before was sensible latent, and obviously producing a cooling effect. Now it follows that the more fluid there is extricated from the body, the more sensible heat will be rendered insensible or latent (passing away from the body with the vapour and diffusing itself in the atmosphere), and so the greater the amount of coolness developed. And the power of secre- ting almost any amount of fluid, and so of abstracting any amount of heat forms one of the many functions of the skin. When, therefore, the system is exposed to great heat as on a hot summer's day, or in a tropical climate, or by great muscular exertion, so that there would otherwise be a danger of raising the temperature of the body to an abnormal elevation, and so put life in peril, the skin im- SYMPATHY BETWEEN THE SKIN AND KIDNEYS. 35 mediately throws all her flood-gates wide open, and the refrigerating agent, in the shape of perspiration, flows out profusely. Thus all injury is prevented. So on the other hand, when the temperature of the medium in which the body is placed is gradually lowered, as by sheltering it from the hot rays of the sun, or by cessation from muscu- lar exercise, these gates are one after another, so to speak, shut up, and the moisture exuding from the body, falls in quantity to the ordinary amount of insensible perspiration. This beautiful sliding-scale power with which the skin is endowed, is still more palpably exemplified in a sudden change of temperature. For instance, while a man is sit- ting over wine and dessert with his convivial friends in a heated dining room, every pore of his skin is eliminating fluid for evaporation. His entire surface feels moist. The whole of the fluid, that is extricated from his body, passes through the skin. The kidneys lie idle. This is to pre- vent the otherwise inevitable consequence, fever. And in this state of artificial excitement, the result of civilization, and the march of intellect, while his stomach is being fretted and irritated by the perpetual droppings of wine into its cavity, over-burthened as it already is by the soup, fish, flesh, and pastry, while the wordy war on politics, lite- rature, or ballet-dancers is exciting his brain, the whole heightened by the glare and heat of fire and candles — where in one word actual fever would be lighted up as an inevitable consequence, the good skin is industriously and untiringly at work to counteract these evil proceedings and prevent the threatened mischief. Let now such a person suddenly emerge from such a state of things into the cold air. He is forthwith in as much danger from the contrary extreme. If his skin continued secreting largely as before, the reaction from his previous over-stimulated or febrile condition would kill him outright, because it would be aided by the evaporation from the surface. But what occurs ? The skin instantly shuts up all her hitherto open 36 CONSEQUENCES OF CHECKED PEESPIEATION. orifices. Superficial evaporation is at once stopped ; and thereby an immense amount of animal heat, that would otherwise have been dispersed, is retained within the body. But there is now another danger of great magnitude to be apprehended. It is this. Whenever a copious discharge of any kind from the body is suddenly interrupted, consi- derable peril is incurred from a fear of the blood being diverted in large quantities from the part, whence the dis- charge had issued, to some internal and vital organ incapa- ble of separating it from the body, as the lungs, heart, or liver. In such cases most serious mischief is to be dreaded. How, then, in the instance just described is such an evil obviated? Most easily. The kidneys, whose functions in the hot dining-room were suspended to accommodate the skin, now in the cold air resume their duties. The same quantity of fluid escapes as before, but through a different channel. And although evaporation follows its emission, it does not occur on the skin, so that no cooling effect on the body is produced. It will now be easily conceived, to speak paradoxically, how inconceivably important to life is this heat-regulating principle, with whose administration the skin is entrusted. And moreover it appears to the author that the reader must agree with him, that an organ deemed worthy to re- ceive so high and vital a trust should be treated with pre- eminent consideration, and shielded from danger with the most scrupulous care. It has been already stated that when any habitual dis- charge from the body receives a check, or is altogether ob- structed, the current of blood that had been determined to the part, whence the flux had issued, and which was necessary to maintain it in activity, is diverted from its course, and being thus diverted must invade some other part of the body. An excellent example of this occurs in vicarious menstruation. In this case the blood, that should pour itself into the tissue of the womb, being from D1ARRHCEA, DYSPEPSIA, CONSUMPTION. 37 some cause or other refused admission into that organ, finds its way into some other, as the lungs, stomach, or nose. Under these circumstances haemorrhage from any of these viscera is no uncommon occurrence. The same thing takes place when the perspiration is obstructed. But, generally speaking, it luckily happens that those very organs that are by nature the best adapted to undertake this supplementary action, and perform the skin's duty, are those upon which it for the most part falls, to wit, the kidneys. As a general rule, perhaps, no great harm results from this arrangement. But if from any cause, as from recent debility, or constitutional delicacy, the kidneys be incompetent to accomplish the extra duty, disease of those viscera is the inevitable consequence. And then the only mode of effectively treating such disease, is at once to strike at the root of the evil, to withdraw from the labour- ing kidneys their unnatural burden, and restore to the skin its proper secretion. Hydropathy does this. Sometimes in obstructed perspiration the unwelcome charge of carrying on its office falls to the lot of the mu- cous membrane of the intestinal canal, and a diarrhoea is the result. In such case there is the same obvious method of cure as in the instance last mentioned, viz., to restore the proper secretion to the skin, thus diverting the flow of blood from the bowels. And hydropathy does this. The blood instead of being determined to the intestinal portion of the mucous membrane, may invest the gas- tric portion, the stomach. Nausea, vomiting, heartburn, acidity, water-brash, and a long array of dyspeptic annoy- ances supervene. In such an example your medicinal armament is of no avail. Nothing will materially benefit the patient, but efficiently restoring to the skin its proper secretion, and it is hydropathy alone that does this. Lastly, the internal irritation arising from deficient or absent action in the skin may manifest itself in the lungs, and cough, difficulty in respiration, expectoration, and in 38 DR. COMBE CURED OF CONSUMPTION bad cases many of the symptoms of pulmonary consumption itself are developed. Indeed there seems to be a very strong link between actual consumption, and want of energy in the cutaneous circulation and secretion, and symptoms of inactivity of the latter, including cold feet and hands, general chilliness and susceptibility to take cold, so com- monly precede the manifestation of the former, that the author is not sure they do not very frequently bear the re- lation to each other of cause and effect. At all events in the early stages of consumption the only possible hope of effecting a cure is through the medium of the skin. It is by influencing the cutaneous functions that riding, and sailing, friction, and emetics have each acquired their sup- porters in the treatment of this English scourge. Speak- ing of the efficacy of sailing in incipient consumption Dr. Andrew Combe details his own case in the following words : " The writer of these remarks became ill in the month of January, 1820, and soon presented many of the symp- toms of pulmonary consumption. In spite of the best advice, he continued losing ground till the month of July, when he went by sea to London on his way to the south of France ; but finding himself unable for the journey, he was obliged to return from London, also by sea. Being extremely liable to sea-sickness, he was squeamish or sick during the whole of both voyages — so much so as to be in a state of gentle perspiration for a great part of the time. After this he became sensible for the first time of a slight improvement in his health and strength, and of a diminu- tion of febrile excitement. Some weeks afterwards he embarked for the Mediterranean, and encountered a suc- cession of storms for the first four weeks, two of which were spent in the month of November in the Bay of Bis- cay in a very heavy sea. For more than three weeks he was generally very sick, and always in a state of nausea ; and during the whole time, although his bed was repeatedly partially wetted by salt water, and the weather cold, the THROUGH THE MEDIUM OF THE SKIN. 39 flow of blood towards the skin was so powerful as to keep it generally warm, always moist, and often wet with perspira- tion, forced out by retching and nausea. The result was that on entering the Mediterranean at the end of a month, and there meeting fine weather, he found himself, though still more reduced in flesh and very weak, in every other respect decidedly improved ; and on his arrival in Italy at the end of seven weeks recovery fairly commenced, after about ten months illness ; and by great care it went on with little interruption, till the summer of 1821, when he returned home." It is manifest in this case Dr. Combe ascribed his inci- pient consumption to a sluggish state of his cutaneous circulation, and consequent deficient perspiration, and at- tributes his cure to their restoration. And as a general rule what remedy so efficient to produce this happy effect as the hydropathic treatment ? One more word on the skin, and the action of hydropathy upon that membrane. The blood in its never-ceasing pro- gressive movement from the heart and lungs, (in which latter organs it has undergone the purifying process of decarbonization) to the periphery of the body, permeating in its course and repairing all the various tissues, passes perpetually from larger vessels into smaller ones, till it ar- rives at those minute hair-like tubes called capillaries. It is in these delicate canals, or rather outside their walls, that the process of formation and demolition, or in one word re- pairing of the body, is executed. Healthy, rosy, arterial blood, fresh from the lungs, exudes out of them. Its fibrine is deposited as good, new, solid tissue, while its oxygen uniting with bad, old, worn-out tissue, exudes back again into them, imparting to it the dark colour of venous or im- pure blood. This fluid now, contaminated as it is, pro- ceeds onwards in its circulating motion to the part from whence it came, the heart and lungs, to be again submitted to the process of purification. And while moving in this 40 THE ORGANS OF CIRCULATION ARE direction, having thus abandoned the arteries for the veins, it is perpetually passing from smaller vessels into larger ones. Now this passage, firstly, from large into smaller channels (in the arteries), and, secondly, from small channels into large (in the veins), is calculated to throw considerable impediment in its course, the former from the increasing amount of friction, the latter from the tendency to stagnation acquired by every fluid emerging from a con- fined into an open space. Having to contend against such obstructions blocking up its path, it follows that to make its way effectually through them, there must be a powerful ms a tergo. Such a vis a tergo every one who has the slightest conception of what he is made, knows to exist in that hollow muscle, the heart, and in the elastic, contractile walls of the arteries. But every one does not know that there is another organ, besides the heart and arteries, that performs most efficient service in aiding to maintain the regularity of the circulation. This organ is the skin, and its medium of action is the perspiration. The important duty alluded to is executed after this manner. " Nature abhors a vacuum," that is, whenever in any given space there is a tendency to the formation of a vacuum, in the surrounding atmosphere there is always a tendency to prevent it by rushing in, and taking the place of the dissipated air. A perfect vacuum has never yet been produced even by artificial contrivances of a chemical or mechanical nature. But without the aid of art, not even the 'partial vacuum, commonly called a vacuum, ever exists for an appreciable length of time. And the greater the tendency to a vacuum, the greater the tendency of the cir- cumambient atmosphere to occupy the would-be void. In a room where there is a fire and a door, there is always a draught between them, that is, a current of air passing from the latter to the former. The heat of the fire rarities the air in the chimney, and would soon generate a vacuum therein, but that a new supply is immediately THE HEART, THE ARTERIES, AND THE SKIN. 41 obtained from the room. This causes the same disposition to a vacuum there, which is prevented by a rush of air through the crevices round the door inwards. All these phenomena are displayed in precisely the same manner and order in the human skin. Perspiration exudes through the coats of a capillary. Instantly there is a ten- dency to the formation of a vacuum in the interior of the vessel. Instantly this tendency is counteracted by a rush of blood from behind. More perspiration escapes. Again a vacuum would be formed, but that more blood hurries to the spot. In this manner then the circulating fluid receives an impetus, not only from a vis a tergo, but also from avis a f route. And in this manner blood is determined to the skin, to the periphery of the body, from the interior, from the large vessels and vital organs. The organs of circulation, therefore, are the heart, the elastic coats of the arteries, and the skin. Which is the most important ? In an El Dorado state they would no doubt be exactly equal in this respect in the animal eco- nomy. But inasmuch as the two first go through their evolutions quite independently of all volitional control, whereas the function of the last maybe influenced in regu- larity and power very much by ourselves at pleasure, and we are not slow to take advantage of this to our own detri- ment, it seems to the author that a study of the last is of far the greatest moment. So that in addition to the host of other evils curtailed upon our unfortunate bodies by a neglect of this most important membrane is that of depriv- ing the blood of one out of three of its organs of circula- tion. And hydropathy, exercising as it does a direct influence upon the skin, must exercise also an indirect in- fluence upon the circulation, and upon diseases of the cir- culation. The fourth organ that is directly susceptible to the influ- ence of external objects, and therefore opens a fourth gate to the approach of disease, is the brain. This is the ma- G- 42 IMPORTANCE OF REGIMEN IN THE terial organ of the mind, and is entrusted with the office of transmitting to the body the mandates of the will. It is the seat of emotion, thought, perception, and all mental and moral faculties. And on this account it holds a much more exalted position than any other part of the body. As the muscular system to be maintained in health, re- quires a regimen of exercise, so also is it necessary duly to regulate the exercise of the brain, to insure the correct performance of its functions. And as by want of employ- ment muscles become weakened and emaciated, bones lose their hardness and bend, and blood-vessels degenerate into solid cords, so does the brain by mental inactivity lose its intellectual vigor, and relapse into imbecility. But the re- semblance extends still farther. For as by violent, over- straining efforts, a muscle may be torn, an artery burst, a bone snapped asunder, so by imposing upon the brain too much mental labour, the delicate structure of that organ may suffer with great severity. Whenever a person labours under considerable mental excitement, an unusual quantity of blood flows into the brain. This can be proved in many ways. But it will be sufficient to relate the following illustrative case. It oc- curred to Dr. Pierquin at the hospital of Montpellier in the year 1821, and is reported by Dr. Caldwell in his " Annals of Phrenology," in these words. " The subject of it was a female at the age of twenty-six, who had lost a large portion of her scalp, skull-bone, and dura-mater in a neglected attack of lues venerea. A corresponding portion of her brain was consequently bare, and subject to inspection. When she was in a dreamless sleep, her brain was motionless and lay within the cranium. When her sleep was imperfect and she was agitated by dreams, her brain moved, and protruded without the cranium, forming cerebral hernia. In vivid dreams, reported as seen by her- self, the protrusion was considerable ; and when she was perfectly awake, especially if engaged in active thought EXERCISE OF THE FUNCTIONS OF THE BRAIN. 43 and sprightly conversation, it was still greater." From this and many similar cases the inference appears indisputable, that the more intensely the mind is occupied, the greater is the rush of blood to the head. This is sometimes car- ried to such an extent in public speaking, where the mental excitement occasionally knows no limit, that the brain has yielded to the engorgement, and the orator been suddenly stricken with apoplexy. This determination of blood to the brain, if the emo- tional excitement that produced it pass away in a short time, inflicts no injury. But if the cause be continued, the force of the cerebral circulation may become so ener- getic as to occasion the laceration of a blood-vessel. The consequence of this of course is most serious. Effusion of blood into the tissue of the brain occurs, and an apo- plectic fit is the result. But far more generally the in- creased rapidity and force of the cerebral circulation relap- ses into a chronic congestion of that organ. Every day we see this well exemplified in that most valuable class of men the commercial community. They very often devote them- selves with such application to their avocations, that they live in a state of constant anxiety. But it is incorrect to limit this state of things to any one class in the present day. For at this moment there seems to be but one ob- ject, that all classes and individuals are endeavouring to reach. That is the accumulation of wealth. Every one is striving to make a fortune. As if that were the aim of existence. As though we were put into the world to amass a heap of money ! A truly paltry pursuit, and this age, which may be called the age of £. s. d., a truly contempt- ible one ! But such being the actual state of things, there is no help for it. It is futile railing against it. If men will rack their brains for the means of gaining in the short- est time the longest purse, those brains will become con- gested. But let me not be thought too sweeping in my observations. Although this results most frequently from 44 DANGEKS OF INTELLECTUAL PEECOCITY. the feverish excitement attendant upon money-making, still it does occur of course to any one devoted to too much head-work, and sedentary habits. Thus the univer- sity student, the literary man, &c. &c, are often the vic- tims of this complaint. Unnaturally precocious intellect in children is decidedly bad. It is almost a certain sign, if the precocity be very marked, of a scrofulous constitution. At all events in the heads of those children, whose premature mental develop- ment distinguishes them from their playfellows, there is always considerable vascular excitement. If this vascular excitement be by judicious means overcome, all may yet go well. But if it continue to increase, it will probably terminate in one of these two ways, namely, either in the production of " water on the brain," or in the deposition of scrofulous tubercle in the cerebral substance. Yet how frequently do ignorant parents by encouraging the forward intellect of their offspring do all they possibly can to foster this excitement, and induce these fatal maladies ! Nor, when the brain is diseased, are the morbid effects necessarily confined to that organ itself. For by means of the nerves that pass from it to every part of the body, it is capable of exciting disease elsewhere in a hitherto healthy locality. And this is frequently the case with congestion of the brain. The symptoms are not merely those which arise from cerebral disturbance, but often such as are associated with disordered digestive viscera. Hence indications of disturbance of the liver and stomach gener- ally accompany those of a labouring brain. The only method of curing these various cerebral affec- tions, or other diseases depending upon a cerebral affec- tion, is to remove the cause of the excitement of the brain. For example, if a person's brain suffer from too close an application to business, he must at all events for a time suspend his business pursuits. If a child evince unnaturally precocious book-learning, let his books be AM IMPORTANT HYDROPATHIC AID. 45 locked up, and himself sent into the fields to play. By no means let his fondness for reading be cultivated. When dyspeptic symptoms supervene upon this taxation of the brain, they will never be eradicated, unless that tax be first repealed. In disorders of the brain, therefore, hydropathic princi- ples are of invaluable service. For they always insist upon immunity of the brain from every source of anxiety, from all conceivable forms of mental excitement. Not even reading is encouraged, unless it be works of the very lightest description. A total relaxation of the brain is enjoined. A continuance of business pursuits is of course always out of the question, at all events in any affection of the head. The fifth and only remaining part, through which disease finds an entrance into the body, is the organs of propaga- tion. A very few words on this subject will suffice. It not unfrequently happens that much debility and malaise owe their origin to too strong an attachment between mar- ried persons. And very often indeed the same circum- stance prevents the recovery of either party, when labour- ing under any complaint, as dyspepsia, or what not. Of course there is but one way to cure this malaise and re- move this obstacle to convalescence. And it is an invaria- ble hydropathic rule that, whichever is the invalid, a tem- porary separation be enforced. This, by the way, is a secret which alone is capable of effecting many important cures. It is most essential to insist upon this disunion in all cases of general debility, nervousness, dyspepsia, and hy- pochondriasis of both the male and female sex. It is equally indispensable in all kinds of diseases connected with the womb, all hysterical affections, &c. &c. An immense amount of evil is incurred also by certain specific maladies. But although a most important subject, this is not the place to discuss it. It has now been seen that disease gains an entrance into 46 THE FIVE GATES OF DISEASE CLOSED. the human system through five channels, namely, the gas- trointestinal canal, the air-passages, the skin, the brain, and the organs of propagation — that to effect a radical cure in any disease whatever, dietetic regimen, the inhalation of pure air, the maintenance in proper order of the functions of the skin, the abstraction of the brain from the excite- ment of any pursuit inducing great mental anxiety, and lastly, a temporary conjugal separation must be considered as indispensable aids And these five salutary regulations are immediately put in force as soon as an invalid, what- ever be the nature of his malady, passes the door of a hydropathic establishment. Is it then a matter of surprise that hydropathy should be capable of curing all curable diseases, and of relieving many that are incurable ? Before concluding the author begs permission to say one more word. It may strike the reader that some important baths are not mentioned in the following researches. In explanation the author begs to state that those only are not mentioned whose physiological action upon the human system so nearly resembles others that are mentioned, that their description would have been an encumbrance. Of this kind are the " dripping-sheet," the "can-douche," the " wash-down," &c. These approach very strongly in re- semblance as to their effects upon the body to the "shallow bath," upon which, it will be seen, many experiments have been made. Having now prepared the reader for certain results that he is to expect, the author trusts he will be more able to recognize and appreciate them in the researches that follow. CHAPTEE II. THE WET-SHEET PACKING. Before presenting to the reader the following eases, which for the sake of clearness and precision have been arranged in a tabular form, it will be necessary to make a few expla- natory remarks. The first six operations were performed on a young man 5 feet 4 inches high, twenty years of age, and 8 stones in weight. His fair complexion, habitually quick pulse, hur- ried respiration and other circumstances, stamped him with the sanguine or excitable constitution. The three last operations were undertaken by a man of a totally opposite character. He was twenty-eight years old, weighed ten stones and a half, stood five feet ten inches, and was a perfect example of the bilious or phleg- matic diathesis. Two men of such opposite temperaments were well-adapted to counterbalance each other. As in the following operations it would be impossible to examine the pulse at the wrist after the commencement of the process of packing, the temporal artery was substituted, which for the information of the non-medical reader, it may be well to mention, is an arterial blood-vessel beating in the temple, and precisely analagous in every respect to the one beating in the arm. The number of respirations (consisting of inspiration and expiration) were counted sometimes by listening to an audi- ble murmur in the breathing, and sometimes by feeling with the hand the rising and falling of the chest. The expression "immediately after " means immediately after the first envelopement of the body by the wet-sheet, and not after the termination of the process of packing. 48 EXPERIMENT ON THE WET-SHEET. So with regard to the ensuing expressions " ten minutes after," &c. By " In shallow bath" it is to be understood that the bather has been removed from the wet-sheet, and placed in a shallow-bath containing fifteen gallons of water, in which latter he has been rubbed for one minute. The expression " In drying sheet " denotes that he has emerged from the shallow-bath, and been enveloped in the dry sheet, in which also now he has been rubbed one minute. The temperature of the sheet was ascertained by enclos- ing therein a thermometer, cautiously preventing contact with the skin. The operations were all conducted in the forenoon, com- mencing at Nine o'clock. FIRST SERIES OF OPERATIONS PERFORMED ON AN EXCITABLE TEMPERAMENT. Operation I. Of One Hour's duration. Pulse Respiration per minute. per minute. Before the process 104 24 Immediately after. 84 32 10 minutes after... 76 28 feels warm all over. 20 minutes after... 72 24 30 minutes after ... 66 24 still warm, and continu- 60 minutes after ... 60 22 ing so during the rest In shallow bath ... 72 24 of the operation. In drying-sheet ... 88 28 Temperature of the wet-sheet, which was still wet and steaming, 93° F. Temperature of the water in the shallow-bath raised from 48.50° F. to 49.25° F. STATISTICS OF OPERATION I. 49 St. lb. OZ. Weight prior to the operation 8 6 \ Weight subsequent to the operation ... 8 5J Loss loz. In this experiment it will be perceived, that on bringing the body in contact with the wet-sheet the pulse at once fell 20 beats in the minute, nearly \ of its whole number of pulsations. It then for the space of one hour, that is the whole period of the envelopement, continued gradually sinking till it counted only 60 strokes, being rather more than § less rapid than it was before the process. By adding together the numbers 84, 76, 72, 66 and 60, and dividing the whole by 5, viz., the number of times the pulse was felt, an average rapidity of pulse per minute for the whole period of the packing may be obtained. But it will not be a correct one, since at the end of forty, and of 50 minutes, the state of the pulse was not ascertained, in the first place, because to do so would have required more time than the author's manifold engagements would have permitted him to devote to the experiment, and in the second place because it was not absolutely necessary, since the same accurate precision can be and is obtained by a mode of calculation which he will lay before the reader. If we consider, as we fairly may, that at those two periods the pulsations were respectively 64 and 62, (the foregoing being 66 and the following 60) and then add them to the five above-mentioned figures, and divide the total by seven, we shall obtain the result 69.14. This may be regarded as a fair estimate of the average rapidity of the pulse during this operation, while lying in the wet-sheet. The only method of acquiring perfect accuracy would be to have the finger on the pulse the whole time. By the application of the wet-sheet therefore the pulse subsided from 104 to 69.14 per minute, being a fall of no less than 34.86 beats. 50 STATISTICS OF OPERATION T. In the shallow-bath after one minute it had risen 12 beats, and after one minute's rubbing in the sheet 16 beats more, reaching then 88, but being still 16 degrees under the original number. With regard to the function of respiration precisely the opposite effects occurred. Before the process was com- menced the man breathed 24 times in a minute. Imme- diately on the application of the wet-sheet, when the pulse fell \ the respiration rose J! becoming 32 instead of 24. It now however began to sink, and continued to do so till the end of the process. But even then, when the pulse had fallen more than f , the respiration had decreased only by 5 2 ? , being 22 instead of 24. If now the figures 32, 28, 24, 24, and 22, with the insertion of 23 twice (as the esti- mated number of respirations that belong to the respective periods of 40, and 50 minutes after the commencement of the process, omitted as mentioned in reference to the pulse) being the intermediate number between 24 prece- ding, and the 22 following, be added together, we shall arrive at the number 176. Divide this by seven, and the average amount of respirations per minute of the whole hour during which the packing lasted, will be the result. And 176 -7-7=25.14, indicating an actual elevation in the rapidity of respiration of 1.14 per minute. While therefore there was a decrease in the beats of the pulse per minute of 34.86, there was an increase in the beats of the lungs, if such an expression may be employed, of 1.14. Now before the commencement of the packing the pulse had been 104, and the respiration 24. These figures then may be taken as expressing the due relation between the lungs and the heart. But as 104 : 24 :: 69.14 : 1 5.95. So that the pulse having subsided from 104 to 69. 14, so also cceteris paribus ought the respiration to have fallen from 24 to 15.95, whereas on the contrary as the pulse fell below the standard, the respiration rose above it. Quod erat demonstrandum. Vide introductory chapter, and analysis of the wet-sheet operations. WET-SHEET PACKING. OPERATION II. 51 In the shallow bath, and after five minutes' rubbing in the dry sheet the respiration rose at the same time as the circulation or pulse. Operation II, Of one hours duration. Pulse, Kespiration, per minute. per minute. Before process 100 24 Immediately after. 72 36 10 minutes after ... 72 28 feels warm and com- 20 minutes after ... 69 27 fortable, and con- 30 minutes after ... 64 1 8.5 tinues so during the 60 minutes after .. . 60 19 operation. In shallow-bath ... 64 24 In drying-sheet ... 72 28 Temperature of the wet-sheet, still wet and steaming, 91° F. Temperature of the water of the shallow bath raised from 52° F. to 52.75° F. st. lb. oz. Weight prior to the operation 8 Of Weight subsequent to the operation ... 8 Loss foz. Between this operation and the preceding one in their main features there is the most striking resemblance. In the first place in reference to the pulse there is the same sudden subsidence on the first application of the wet- sheet — the same subsequent gradual depression for the the whole hour, — and the same reaction in the shallow-bath, and drying-sheet, but less marked than in the first opera- tion. But there is another and truly remarkable similarity. If we look for the average number of beats of the pulse during the entire period of envelopement as in the last expe- 52 STATISTICS OF OPERATION II. riment (viz., by adding the figures 62 twice to the numbers 72, 72, 69, 64 and 60, and dividing the sum by 7) we shall obtain 65.85 as the result. Now before the commencement of the process the pulse had been 100. This indicates a fall therefore of 34.15 per minute, for 100—65.85=34.15. In the preceding operation the corresponding fall was 34.86, the difference being merely a fraction. As regards the respiration too, there is a general corres- pondence between the first and second operation, but less perfect. The average number of respirations per minute for the whole hour is to be acquired in the same way as before, employing the figures 18.75 twice for the inserted amounts. It will be found to be 23.71, being a decrease from the original number by 00.29. In this case therefore, while the pulse sunk 34.15 beats in the minute, the respiration instead of falling in a corresponding ratio remained as nearly as possible stationary. If the respiratory process had fallen in a corresponding ratio to the circulatory one, its average frequency during the packing would be about 15.80, for as 100 : 24 : : 65.85 : 15.80. Instead of which it was 23.71, that is 7.91 degrees more elevated than the latter, and indicating a fall from the original amount of only twenty-nine hundredths. And this may virtually be considered as an increase in the rapidity of the respiration. Quod erat demonstran- dum. Vide Introductory Chapter, and the Analysis of the wet-sheet operations. WET-SHEET PACKING. OPERATION III. 53 Operation III, Of one hour and ten minutes duration. Pulse, Respiration, per minute. per minute. Before process 100 24 Immediately after. 80 32 10 minutes after... 66 23.5 feels warm and 20 minutes after... 66 20 moist, and remains so 30 minutes after ... 62 23 throughout, becom- 60 minutes after ... 58 18 ing towards the end 70 minutes after ... 58 18 quite hot. In shallow-bath ... 96 26 In drying-sheet ... 77 21 Temperature of the wet-sheet 93° F. Temperature of the water in the shallow bath raised from 48° F. to 49.33° F. st. lb. oz. Weight prior to the operation 8 10^ Weight subsequent to the operation... 8 9 Loss... 1| On adding together the figures 80, 66, 66, 62, 58 and 58, with the insertion of 60 twice to indicate the state of the pulse at the expiration of 40 and 50 minutes, and dividing the answer by 8, an average of 63.75 beats of the pulse per minute will be obtained. This shews a diminution of 36.25 beats, the original pulse having been 100, and 100—36.25=63.75. If the figures placed under the respiration be treated in the same way, inserting the number 20.5 twice, as repre- senting the middle quantity between 18 and 23, we shall get as the result 21.93. Here also is seen a decline in speed from the original state of the respiration, the declension being in amount 2.07, for 24—2.07=21.93. 54 WET-SHEET PACKING. OPEKATION IV, As the pulse was 100 before the commencement of the process, and the respiration 24, we may look upon those figures as representing the (in ordinary circumstances) just balance between the heart and lungs. But 24 : 100 : : 15.3 : 63.75. Wherefore the pulse having sunk to 63.75 the corresponding number of respirations would be 15.3. While however the former fell 36.25 in the minute, the latter fell only 2.07. And under the circumstances this may be considered vitually an elevation of the respiration, through the immense subsidence of the pulse. Operation IV, Of one hour and a half's duration. Pulse, Respiration, per minute. per minute. Before process...... 104 18 Immediately after. 82 « 40 10 minutes after... 72 23 feels warm. 20 minutes after... 70 24 feels quite hot, but 30 minutes after... 64 22 moist. There is no 60 minutes after... 63 19 perspiration on the 90 minutes after... 60 19 forehead. In shallow bath ... 74 26 In drying-sheet ... 84 26 Temperature of the wet-sheet 93° F. Temperature of the water in the shallow-bath raised from 49.25 c F. to 50.00° F. st. lb. oz. Weight prior to the operation 8 7 J Weight subsequent to the operation 8 6 Loss... 1J The results of this operation as far as the pulse is con- cerned exhibit a general similarity to the three preceding ones, but in reference to the respiration more particularly resembles the first. For while there is an enormous fall in the pulsations of the artery, in those of the lungs there is WET-SHEET PACKING. OPERATION V. 55 an actual increase. The average beats of the former, (found by adding up the numbers 82, 72, 70, 64, 63 and 60, and supplying the four extra ones 63.5,63.5,62 and 61, as before explained, and dividing the whole by the number of times, apparent and real, that the pulse was examined, viz. 10) will be ascertained to be 66.1 each minute of the hour and a half. Here is manifest a fall of 37.9 beats per minute, for 104—66.1=37.9. The average amount of respirations per minute for the whole period of an hour and a half (discovered by adding the supplied numbers 21, 20, 19, 19, to those shewn in the above table, viz., 40, 23, 24, 22, 19, 19, and dividing the answer by 10) will be found to be 22.6, and consequently will betoken an elevation of 4.6, for 18+4.6=22.6. Operation V. Of one hour and forty minutes' duration. Pulse, Respiration, per minute. per minute. Before process 92 22 Immediately after. 64 32 1r . • , r., nA 01 ("feels quite comforta- 10 minutes after... 64 24<, n Q ^ , ,, ^ble & no longer cold. 20 minutes after... 71 24 feels quite warm. 30 minutes after... 64 22 60 minutes after. . . 62.5 22 1 h. and 40m. after 53 22 In shallow-bath ... 84 21 In drying-sheet ... 84 29 Temperature of the wet-sheet 90° F. Temperature of the water in the shallow-bath raised from 53° F. to 54° F. st. lb. oz. Weight prior to the operation 8 4 1 Weight subsequent to the operation 8 2| Loss... 2 J 56 STATISTICS OF OPERATION V. In this operation there occurs a strange anomaly. There is an abrupt elevation of pulse which takes place at the elapse of 20 minutes, and curiously interrupts the ordinary gradual depression of its rapidity. After the pulse had sunk from 92 to 64, and remained at the latter point sta- tionary for some time, it in a remarkable manner, and for some reason which the author cannot explain with certainty, rises to 71. It does not however continue to rise, but quickly subsides again, eventually to fall considerably lower than is usually the case. It not unlikely that the individual packed made some little bodily effort, perhaps in the endeavour to liberate a cramped arm, in the exertion of coughing, or some such trivial muscular exertion. Most probably the abrupt ele- vation of pulse was attributable to some petty casualty of this description. The average rapidity of the pulse during the hour and forty minutes is to be calculated by adding together the figures 64, 64, 71, 64, 62.5, and 53, with the superaddi- tion of the numbers 63.25, 63.25, 60.11, 57.74, 55.37 to supply the omissions (as already explained), and dividing the whole by 11. It will be found to be 61.66, indicating a fall of 30.34 from the original state of the pulse before the bath, for 61.66+30.34=92.00. In case it may be imagined that the employment of so many supposititious figures falsify the experiments or their inferences in any manner, the author begs to observe that their omission entirely would only slightly alter the results, and that he calls in their aid to impart to the operations as much mathematical precision as possible. In the example before us, were no supplementary figures employed, the average pulse (calculated simply by adding together the figures 64, 64, 71, 64, 62.5, and 58, and dividing the sum by 6), would be seen to be 63.08, exhibiting a difference only of 1.42, and not so truly correct as the first estimate, viz., 61.66. Of course the same remark applies to the calculations regarding the respiration. WET-SHEET PACKING. OPERATION VI. 57 The average number of respirations per minute for the whole time, investigated in the same way (viz., by adding to the figures 32, 24, and 24, for every subsequent ten minutes 22, that is 3 times, and dividing by 11), will be ascertained to be 23.27. The original numbers being before the process 22, there is here manifested a rise of 1.27. Operation VI. Of two hours and a half's duration. Pulse, Respiration, per minute. per minute. Before process 96 19 Immediately after. 84 82 10 minutes after ... 70 22 becoming warm and 20 minutes after ... 72 22 comfortable. 30 minutes after ... 72 21 1 hour after 64 21 2 hours after 64 24 Forehead still dry. 2 hours and 30 m. 64 27 Nowhere sweating. In shallow-bath ... 76 24 In drying sheet ... 76 25 Temperature of the wet-sheet 95° F. Temperature of the water in the shallow-bath raised from 60.75° F. to 61.75° F. st. lb. oz. Weight prior to the operation 8 1 7f Weight subsequent to the operation ... 8 1 5J Loss... gj In this operation the subsidiary figures will be found to be 69.34, 66.67, for the interval between 30 minutes and 1 hour, 64, four times repeated for the interval between 1 and 2 hours, and the same number, once repeated, for the interval between two hours, and 2 hours and a half. By adding these nine numbers to those in the above column that stand between 96 and 76, and dividing the result by 16, 58 WET- SHEET PACKING. OPERATION VII, the average rapidity of the pulse during the whole process will be found to be 67.12. These subsidiary figures may make the calculations a little complicated, but cannot be discarded, since they impart great accuracy to the experi- ments. In the present instance without their employment the results would be materially altered. The pulse would be estimated to beat 70 times in the minute instead of 67.12. The latter number indicates a fall from the origi- nal state of the pulse of 28.88 for 96— 28.88=67.12. The average quickness of the respiration is to be ascer- tained by employing the supplementary figures 21, 21, 21.5, 22, 22.5, 23, 23.5, 25, and 26, and adding to these numbers 32, 22, 22, 21, 21, 24, 27, as they occur in the above column, and dividing the whole by 16. The repre- sentative number will be 23.4, expressing an elevation from the original rate of speed of 4.4 for 19+4.4=23.4. SECOND SERIES OF OPERATIONS, PERFORMED ON A PHLEGMATIC TEMPERAMENT. Operation VII. Of four hours' duration. Pulse, Respiration, per minute. per minute. Before process 72 17 Immediately after. 52 18 10 minutes after... 54 25 getting slowly warm 20 minutes after ... 52 22 30 minutes after ... 48 18 moderately warm, 1 hour after 44 18 never hot. 2 hours after 42 ...... 18.5 3 hours after 42 18 4 hours after 46 26 In shallow-bath ... 72 26 In drying-sheet ... 72 24 Temperature of the wet sheet 95° F. STATISTICS OF OPERATION VII. 59 Weight prior to the operation ..... 10 7 10 Weight subsequent to the operation 10 7 6f Loss... S\ As before mentioned, it will be perceived from the weight of the person who underwent this operation that it was a different individual. The first one was of a sanguine, excitable temperament, the disposition of the latter de- cidedly phlegmatic. It is important that the reader should retain this distinction in his recollection. It may be as well here to caution the reader against so much as dreaming of continuing the action of the wet sheet for so long a period as described in these examples. In some cases, and without constant attention, it might be attended with considerable risk. The chief object even in the instance before us of prolonging the operations to so many hours was to contrast their effects with those of the sweating blankets, and to prove that they are not, as is generally supposed, of a diaphoretic character, however long they may be endured. The average speed of the pulse during the four hours may be satisfactorily obtained by adding together and di- viding by 25 the following figures, 52, 54, 52, 48, 46.66, 45.33 (the latter two numbers for the periods of 40 and 50 minutes after the commencement) 44, 43.65, 43.32, 42.99, 42.66, 42.33, (the latter five numbers respectively for each ten minutes between the one and two hours) 42, 42, 42, 42, 42, 42, (the latter five numbers respectively for each ten minutes between the two and three hours) 42, 42.67, 43.34, 44.01, 44.68, 45.35, (the latter five between the three and four hours) and 46. The result of this sum is 44.68. Here therefore is shewn a decrease of 27.32 beats in the minute, for 72—27.32=44.68. Once more the author feels it incumbent upon him to apologise to the reader for this horrible accumulation of 60 STATISTICS OF OPERATION VII. dry figures. It is to the kindly disposed reader alone that this apology is made. But there are other readers of a severer class, who listen incredulous to a man's story, till fact and proof are produced. And it is to establish con- viction in the minds of this critical sort that the author has recourse to so many figures. He hopes that the for- mer benevolent and non-sceptical reader will at once pass over them, when they stand in his way, and prove unin- teresting. The respiration on the other hand will be found to pre- sent an increased ratio of speed by the application of the wet-sheet, for on adding together the figures 18, 25, 22, 18, 18, 18, (the latter two numbers answering to the periods of forty and fifty minutes) 18, 18.08, 18.16, 18.24, 18.32, 18.40, (the latter five answering respectively to each ten minutes between one and two hours) 18.50, 18.40, 18.32, 18.24, 18.16, 18.08, (the latter five being the five previously mentioned numbers reversed, and answering to the interval of two and three hours) 18, 19.33, 20.66, 21.99, 23.32, 24.65, (the latter five corresponding to the interval between the three and four hours) and 26, and then dividing the whole by 25, the product will be 19.67, and the index of the average rapidity of the respiratory movements during the whole time of lying in the sheet. Thus there will be discovered a rise of 2.67 in the minute, since 17+2.67=19.67. In reference therefore to the relation between the breathing and the pulse, that is, between the undulatory movements of the chest and the pulsations of the arterial system, the same principle that was so constant in the first six operations, is still preserved, (although the individual treated is different, and of a totally different constitution,) that is to say, the depressing effect on the pulse, and the elevating effect on the respiration. WET- SHEET PACKING. OPERATION VIII. 61 Operation VIII, Of four hours' duration, Pulse, Respiration, per minute. per minute. Before the process. 72 20 Immediately after.. 54 20 after the first few 10 minutes after ... 52 24 minutes he describes 20 minutes after .. . 47 25 himself as very com - 30 minutes after ... 45 22 fortable, but neither 1 hour after 42 .... 31 warm nor cold, du- 2 hours after 42 22 ring the whole pro- 3 hours after 43 26 cess. 4 hours after 44 26 In shallow bath.... 60 26 In drying sheet 60 26 Temperature of the wet-sheet 93° F. st. lb. oz. Weight prior to the operation 10 6 8 J Weight subsequent to the process 10 6 6 J Loss If The average rate of the pulse per minute during the four hours is calculated by adding together and dividing by 25 the following figures, 54, 52, 47, 45, 44, 43, (the latter two subsidiary as before explained in the preceding opera- tion) 42, 42, 42, 42, 42, 42, (the latter five numbers sub- sidiary) 42, 42.17, 42.34, 42.51, 42.68, 42.85, (the latter five subsidiary) 43, 43.17, 43.34, 43.51, 43.68, 43.85, (the latter five subsidiary) and 44. The result of this calcula- tion will be 43.84, indicating a fall from the original state of the pulse before the process of 28.16, for 72 — 28.16= 43.84. The average rapidity of the respiration is calculated by adding together and dividing by 25 the following figures, 20, 24, 25, 22, 25, 28, (the latter two numbers being sub- sidiary) 31, 29.5, 28, 26.5, 25, 23.5, (the latter five subsi- 62 WET-SHEET PACKING. OPERATION IX. diary) 22, 22.67, 23.34, 24.01, 24.68, 25.35, (the latter five subsidiary) 26, 26, 26, 26, 26, 26, (the latter five subsidiary) 26. The result will be seen to be 25.26, exhibiting a rise of no less than 5.26, for 20 + 5.26 = 25.26, and that too while the pulse sinks 28 beats ! Operation IX, Of four hours 1 duration. Pulse, Respiration, per minnte. per minute. Before the process. 60 24 Immediately after . 56 25 experiences what he 10 minutes after... 48 20 calls a comfortable, 20 minutes after ... 46 25 soothing, and pleas- 30 minutes after... 44 21 ing effect, but is not 1 hour after 42 19 decidedly warm. 2 hours after 40 20 3 hours after 40 19.5 4 hours after 44 20 In shallow bath .... 56 28 In drying sheet.... 72 28 Temperature of the wet-sheet 92° F. Temperature of the water in the shallow bath raised from 47.5° F. to 49° F. st. lb. oz. Weight prior to the process 10 6 0J Weight subsequent to the process 10 6 Loss. By adding together and dividing by 25 the following figures 56, 48, 46, 44, 43, 43 (the last two subsidiary) 42, 41, 41, 41, 41, 41 (the last five subsidiary) 40, 40, 40, 40, 40, 40 (the last five subsidiary) 40,40.66, 41.32/41.98, 42.64, 43.30 (the last five subsidiary) and 44, the numbers 42.43 will be obtained. These denote the average rate of speed with which the pulse moves per minute during the process, and indicate a fall from the original rapidity before ANALYSIS OF THE WET-SHEET OPERATIONS. l33 the commencement of the operation of 17.57 beats, for 60 — 17.57=42.43. This is the slightest diminution that has yet been observed, and for a good reason, as will be afterwards explained. (Vide the analysis of the wet-sheet operations.) With regard to the respiration also there is the same singularity attached to the operation now nnder examina- tion. It will be found on instituting the usual investiga- tion that the breathing subsides in rapidity on the average during the whole process nearly four degrees in the minute. For on adding together and dividing by 25 the following numbers, 25, 20, 25,21, 20, 20, (the two last subsidiary) 19, 19.17, 19.34. 19.51, 19.68, 19.85, (the last five sub- sidiary) 20, 19.90, 19.82, 19.74, 19.66, 19.58, (the last five subsidiary) 19.50, 19.58, 19.66, 19.74, 19.82, 19.90, (the last five subsidiary) 20, the dividend will be 20.17. This shews a decrease in the respiratory movements of 3.83 per minute, for 24—3.83=20.17. Analysis of the Wet-Sheet Operations. The commencement of the first analysis in the work will afford a fit opportunity for the author's requesting parti- cularly the general reader's attention to the matter con- tained in them all. They will be a summary of the results of all the preceding experiments, taking also a compara- tive view and review of the whole. While the accuracy of the details of the operations is intended to captivate the attention of the purely scientific and critical eye, the final analytical review and to a certain extent recapitula- tion is more adapted to the perusal of everybody else. Let us now at once commence with the analysis of the wet-sheet operations. In the first place let the author draw the attention of the reader to the fact of the two persons submitted to the wet-sheet packings being well marked specimens of antago- nistic temperaments. The natural disposition of the first 64 ANALYSIS OF THE WET-SHEET OPERATIONS. one was excitable, nervous, sanguine, both mentally and physically. That of the second was just the very contrary, essentially phlegmatic as a Dutchman. All temperaments whatsosver may be and are resolvable into one or other of these two, or into compounds of both containing various proportions of each. In truth there are but two of what may be called pure temperaments, and they are those just mentioned. All others, as bilious, leuco-phlegmatic, &c. &c. are but modified forms of the same. Averages, there- fore, deduced from these two opposing and extreme forms of constitutional temperament will probably serve in as correct a manner as possible to illustrate the effects of hy- dropathic measures upon the general mass of individuals. For of course the mean of two extremes must be a moderate ratio. So here a medium drawn from the effects of certain measures on a very excitable and on a very phlegmatic dis- position must be the same as the effects of the same mea- sures upon persons neither so excitable nor so phlegmatic. In the first six operations the pulse at the commence- ment of the process will be found to be, beginning with the first, as follows, 104, 100, 100, 104, 92, 96. This will yield an average of 99.33. The great elevation above the normal rapidity here shewn is one circumstance, whence is deduced the peculiar temperament of this individual. In the same operations, the pulse, immediately after the body was enveloped in the sheet, was respectively 84, 72, 80, 82, 64, 84. The medium number of these six is 77.66. And 99.33— 77.66=21.67. Thus then in the time that it takes for a man to lie down, and have the two ends of a sheet lapped over his body, in one minute, sometimes in less than one minute, is the pulse fallen nearly twenty- two beats in the minute ! In less than one minute twenty-two beats ! Was not this, before the discovery of the wet- sheet, inconceivable ? In the seventh, eighth, and ninth operations, namely, those performed by the individual of the phlegmatic dia- EFFECT OF THE WET-SHEET UPON THE PULSE. 65 thesis, the numbers indicating the rate of speed of his pulse before the processes were these, 72, 72, 60; observe the forcible contrast here exhibited between the present and the preceding example, and occasioned by the differ- ence in temperament. The medium amount of these then is 68, more than thirty degrees lower than the foregoing, which was 99.33. The numbers denoting the pulse imme- diately following the wet-sheet wrapping were respectively 5'^, 54, 56. The average here is of course the middle figure 54. And 68 — 54=14. This subsidence of fourteen pulsations in the minute is every whit as remarkable as the previous fall of twenty- two. For what has been before stated about the difference of their temperaments must now be taken into considera- tion. A man of cold, phlegmatic constitution is always less susceptible to external influences than one of the con- trary disposition. Therefore it would be imagined a priori, that the wet-sheet would produce less marked arterial de- pression in the latter three cases than in the six former. Besides which the pulses being so most dissimilar in rapi- dity at the commencement of the process, the average being in the one case 99, and in the other 68, the former could afford, so to speak, to lose much more speed than the latter. If now we draw an average from the two cases unitedly by adding 99.33 to 68, and dividing the quotient by two, we shall obtain as a result 83.66. And by doing the same thing with regard to the pulse immediately after the en- velopement we shall get the figures 65.83. And 8S.66 — 65. 83=:17. 83. This, therefore, a result gained by the com- parison of two perfectly opposite natures, may be fairly stated to be the average amount of diminution of the pulse by the first application of the wet-sheet. The average rapidity of the pulse for the whole duration of the process was in the first case 69.14, in the second 65.85, in the third 63.75, in the fourth 66.10, in the fifth 6() EfcTECT OF THE WET-SHEET UPON THE PULSE. 61.66, in the sixth 67.12, in the seventh 44.68, in the eighth 43.84, in the ninth 42.43. The constancy and con- sistency of these results are perfectly astonishing. The resemblance lies, as of course it should, among the first six between each other, and among the three last between each other. Combining the two divisions and estimating a general average from the whole number, we shall find such average to be 58.28. This shews a farther reduction below that induced immediately by the application of the cold sheet, of 7.55, for 65.83—7.55=58.28. From these statistics it may be very properly inferred that as a general rule the pulse usually falls about seventeen beats in the minute on the first application of the wet-sheet, and subsides during the process seven or eight degrees more — provided the pulse before the operation be in the state in which it ought to be after moderate exercise, to wit, number- ing about eighty-two or three — moreover, that when the pulse preceding the process is much more rapid than this, a much greater depression occurs, and when on the other hand it is less rapid than this before the process, the diminution is less marked. Hence it appears of what extreme efficacy this opera- tion may be in the treatment of febrile diseases. When a person labours under the following symptoms, namely, an accelerated pulse, a hot and dry skin, a furred tongue, loss of appetite, troublesome thirst, &c. &c, he is said to be the subject of fever or feverishness. This febrile excite- ment may be in the shape of a specific fever, as typhous or common continued fever, ague in its hot stage, small- pox, or measles, or it may be merely the general disturb- ance of the system associated with some local inflamma- tion, as pleurisy, inflammation of the bowels, &c. And this state of the system, however modified by casual cir- cumstances, as contagion, inflammation, or anything else, is commonly recognised as fever or a febrile paroxysm ; but in truth it is only one stage of the complaint. It is the THE THREE STAGES OF FEVEK. 67 hot stage, but it is preceded by a cold one, and followed by a sweating one. The cold stage is characterized by a pallor and shrinking of the skin, and a feeling of chilliness. The sweating period bedews the tense and dry skin with moisture, reduces its heightened temperature, and restores the hither- to exalted pulse to its natural standard. These then are the stages of lever of all kinds, whether hectic, exanthe- matous, typhous, inflammatory, or any other. At the onset of the malady the blood is driven from the skin to the internal organs, the heart, liver, lungs, and large vessels, thus clearly accounting for the symptoms developed at the first period, namely, the feeling of coldness, the sensation of a stream of water trickling down the spine, the bristling of the hair, the knocking of the knees, and chattering of the teeth, and the general pallor and contraction of the whole surface. After a time the struggling heart and large vessels emanating from it by gigantic efforts try to relieve themselves of their superabundant contents, and with suc- cess. They manage to pump the blood, with which they have been during the cold fit surcharged, back into the superficial and cutaneous capillaries. And now the reac- tion occurs. The blood urged onward by the full force of the central circulating powers, rushes with violence into the tissues of the skin, and coursing tumultuously through their minute vascular channels over the whole surface of the body, creates the greatest excitement. Chilliness and shivering give place to flushes of heat, which grow more and more intense, and more prolonged. The cold, con- tracted skin inflames and burns. The arteries leap and throb. The tongue becomes dry and the throat parched, and the second or hot stage is fairly established. After this period has endured a certain time, the turgid vessels of the skin seek and obtain relief by the opening of their natural locks, the perspiring apparatus. These gates un- close, and a copious discharge of sweat is followed by instant 68 THE TREATMENT OF FEVER BY relief. The hot and thirsty tongue is cooled and moisten- ed. The fiery flush of the skin is quenched. The noisy, and painful beating of the arteries is stilled. The pulse keeps more moderate time, and the whole system is soothed and quieted. . This is the natural termination of an attack or par- oxysm of fever. The whole paroxysm may last but a few hours, as is the case in quotidian ague, or it may last seve- ral weeks, as frequently happens with common contagious fever. But in whatever garb the disease may be clothed, it always follows this course. This succession of symp- toms constitutes the essence and sine qua non of fever. The next matter to be enquired into is, as to the objects to be aimed at in the artificial treatment of the disease. Now in attempting to combat a disorder by the employ- ment of any artificial remedy, we should always closely inspect nature, to see what means she brings to bear upon the complaint when left to her own management. In the present instance, viz. that of fever, we see that she abates the inflammatory tumult by cooling the skin, this being effec- ted by perspiration. But how does the perspiration cool the skin ? By evaporation from its surface, a large quantity of specific or sensible heat being by that process rendered latent or insensible. So that nature herself gives the fevered patients a cold bath, producing the water from her own engorged capillaries. Medical practice following correctly the dictates of nature prescribes various simple sudorific medicines to effect this desirable end. To generate perspiration, in other words to supply a cold bath, she has recourse to a little antimony, a little ipecacuanha, a little acetate of ammonia, and so on. Sometimes these mild remedies pro- duce a slight effect, more frequently none whatever. The theory and principal of action, and intention too are excel- lent enough, but how insufficient the practice all the world knows. Indeed so futile are all medicines in simple NATURE, MEDICINE, AND COLD WATER. 69 fever, and when effective so harmful their effect, that it is pretty generally considered by medical men that the less they interfere with a patient suffering from fever, the more likely is he to weather the point of danger. Now see what hydropathy can do. She also like her neighbour physic watches the in- structions of nature with a jealous eye. She too like her co-temporary observes the method to which nature has recourse to cool the patient. She is delighted to see the cold bath, in which the patient bathes with such happy and refreshing results. When therefore such a malady is pre- sented to her scrutiny, and its cure entrusted to her treat- ment, she strives at once to imitate her guide ; but how ? Simply by the employment of an artificial cold bath. And the best form of cold bath that can be employed in these febrile affections is the wet-sheet packing. On account of its excellent effect in soothing pain, allaying irritation, and exercising a general tranquilizing power it is more adapted for this object than any other kind of bath. But this remedy should always be used in the middle or hot stage, if possible. It must never be employed in the cold one, and rarely, if ever, in the sweating one, cer- tainly never if the perspiration be at all profuse, or if it has been going on for some time. The reason of its pro- hibition in the first stage of fever must be obvious to every one; and perspiration being itself a powerful cooling agent of course, when fully established, requires no aid from without. If what is called common continued fever, or typhus, be submitted to a close scrutiny, it will be be found gene- rally the subject of distinct remissions and exacerbations. It is in fact nearly always increased in severity towards night, and alleviated in the morning. A more distressing thrist, greater restlessness, and an increased amount of general febrile excitement denote with sufficient clearness the ex- acerbation, while an abatement of these symptoms point 70 THE BEST HYDROPATHIC FEBRIFUGE. out the remission. When an obvious paroxysm such as this can be discovered, it should always be chosen as the fit time for the administration of the wet-sheet packing. But whenever there is a sense of chilliness present, or the skin is not hot and dry, or there is any considerable perspira- tion, then the cold application must be postponed to a more fitting opportunity. The employment of the wet-packing is followed by a beneficial and grateful perspiration, which is quickly suc- ceeded in turn by calm and refreshing slumber. It is universally admitted by the first authorities, that the best form for administering cold water treatment in fevers is the wet-sheet packing. But the author is going to introduce some cases (to shew the value of the wet-sheet in these diseases) that were not treated by the wet sheet. This may appear inconsistent, but it will answer the end he has in view. The cases were treated with cold affusion, but it was before the wet-sheet was known. However suc- cessful the results therefore, it is to be fairly presumed they would have been at least as successful, if not more so, had the more efficient antiphlogistic remedy the wet-sheet been substituted for the cold affusion, for the reasons above mentioned. Why the author does in preference choose to illustrate his observations by cases not treated with the wet- sheet is this. He wishes for obvious reasons to quote from a non-hydropathic author, especially as he has an opportunity of doing so from so eminent a physician as Dr. James Currie, of Liverpool ; from that gentleman's Medical Reports the following narrative is extracted. "In a dark, narrow, and unventilated cell off the guard- room, it was usual to confine such men as were sent to the guard for misbehaviour, and about the 20th of May, 1792, several men had been shut up in this place on account of drunkenness, and suffered to remain there twenty-four hours, under the debility that succeeds intoxication. The typhous or gaol fever made its appearance in two of these CASES OF FEVER TREATED BY COLD WATER. 71 men about the 1st of June, and spread with great rapidity. Ten of the soldiers labouring under the complaint were received into the Liverpool Infirmary, and the wards alot- ted to fever could admit no more. The contagion continu- ing its progress, a temporary hospital was fitted up at the fort, and I was requested to give my assistance there to a surgeon of the regiment, by Captains Brereton and Torriano. In two low rooms, each about fifteen feet square, were fourteen patients labouring under fever. They were in different stages of its progress : one was in the fourteenth day of the disease, two were in the twelfth, and the rest from the ninth to the fourth inclusive. The symptoms of the fever were very uniform. In every case there was more or less cough, with mucous expectoration : in all those who had sustained the disease eight days and upwards there were petechias on the skin : in several there were occasional bleedings from the nostrils, and streaks of blood in the expectoration. The debility was considerable from the first, and it had been increased in several cases by the use of venaesection, before the nature of the epidemic was understood. The pulse varied from 130 strokes in the minute to 100: the heat rose in one case to 106° F., but was in general from 10T to 103° ; and towards the latter stages of the disease it w r as scarcely above the temperature of health. Great pain in the head with stupor pervaded the whole, and in several instances there occurred a con- siderable degree of low delirium. Our first care was to ventilate and clean the rooms, which were in a high degree foul and pestilential. Our second was to wash and clean the patients themselves. This was done by pouring sea water, in the manner already described, over the naked bodies of those whose strength was not greatly reduced, and whose heat was steadily above the temperature of health. In those advanced in the fever, whose debility was of course great, we did not venture on 72 OASES OF FEVER TREATED BY COLD WATER. this treatment, but contented ourselves with sponging the whole surface of the body with tepid vinegar, a practice that in every stage of fever is salutary and refreshing. Our next care was to stop the progress of the infection. With this view the guard-house was at first attempted to be purified by washing and ventilation, the greater part of its furniture having been burnt or thrown into the sea. All our precautions and exertions however were found to be ineffectual. The weather was at this time wet and ex- tremely cold for the season ; the men on guard could not be prevailed upon to remain in the open air ; and from passing the night in the infected guard room, several of the privates of the successive reliefs caught the infection, and fell ill on the 10th, 11th, and 12th of the month. In seve- ral of them the fever ran through its course ; and in others it was immediately arrested by the affusion of sea-water as already described. No means having been found effec- tual for the purification of the guard-room, it was shut up and a temporary shed erected in its stead. Still the con- tagion proceeded: in the morning of the loth three more having been added to the list of the infected. On that day therefore the whole of the regiment was drawn up at my request, and the men examined in their ranks. Seven- teen were found with symptoms of fever upon them. — It was not difficult to distinguish them as they stood by their fellows. Their countenances were languid, their whole appearance dejected, and the tunica adnata of their eyes had a dull red suffusion. These men were carefully separated from the rest of the corps, and immediately sub- jected to the cold affusion, always repeated once, and sometimes twice a day. — In fifteen of the number the con- tagion was extinguished ; but two went through the regu- lar disease. On the same day the commanding officer, at my desire, issued an order for the whole of the remaining part of the regiment to bathe in the sea ; and for some time they were regularly mustered and marched down at high water to plunge into the tide. CASES OF FEVER TREATED BY COLD WATER. 73 These means were successful in arresting the epidemic ; after the 13th of June no person was attacked by it. It extended to fifty-eight persons in all, of which thirty-two went through the regular course of the fever, and in twenty- six the disease seemed to be cut short by the cold affusion. Of the thirty-two already mentioned two died. Both of these were men whose constitutions were weakened by the climate of the West Indies ; both of them had been bled in the early stages of the fever ; and one being in the twelfth, the other in the fourteenth day of the disease, when I first visited them, neither of them was subjected to the cold affusion." Here then were fifty-eight cases of which fifty-six were treated hydropathically and all recovered, and two treated by the regular practice and both died. Of the fifty-six cured thirty were conducted safely through the disease, but in twenty-six the fever was not permitted even to run its course, but was at once attacked and annihilated by the cold affusion. But according to the recent hydropathic discove- ries, eminently successful as this treatment was, the wet- sheet would have been the more fit remedial application. The latter indeed is now the nearly universal form in which fever is treated by cold water. The author w T ill now take the liberty of citing two or three more examples of the curative effects of cold water (and therefore in particular of the wet-sheet) in fevers. They are again taken from the work of cele- brated hydropathic physicians. This work is entitled f 'yrvxpo\ov while out walking at a / moderate pace. 10 45 .... 11 .. 68 ... .. 68 .. .... 14.5 .... 17 1 sitting quietly in his / study. 1 1 20 .... .. 66 ... .. 60 .., .... 15.5 .... 15.5 > dining at half-past 1. 2 15 .... .. 12 .. .... 18 2 45 .... .. 70 .. .... 15.5 5 6 8 ..• 88 .. .. 63 .. .. 71 .. .... 30 .... 17 .... 16.5 ( while out walking at I a moderate pace. ^ sitting quietly in his Y study. Tea was 11 .. 64 .. .... 16 y taken at 7 p.m. 152 STATISTICS OF THE SHALLOW BATH OPERATIONS. At this point it was considered that a sufficient number of experiments had been performed to warrant a confident re- liance on the event, as being as near as possible to the truth ; and more especially so as it was found now, that on adding together the figures in the second column, and di- viding the sum by 18 the result, which will denote the average rapidity of the pulse, was found to be 72.73. This number, minus the fractional figures, is actually the one, that by universal consent represents the standard pulse of health. This being the case it becomes a priori most reasonable to consider the average rate of the respiratory movements, whatever it may be, that shall follow on an analysis of the same experiments, which yielded the stan- dard pulse, to be the standard respiration. If the third column of figures be added together and divided by 18, the average and, we may now add, standard rapidity of respiration will be indicated by the result. This result is 19.31. The correct rapidity of the respira- tion therefore bears the same relation to that of the pulse as 19.31 does to 72.73. And as 72.73 : 19.31 : : 3.76 : 1. Therefore for every respiration there should be, to preserve their due equilibrium, 3.76 or nearly four beats of the pulse ; or vice versa, for four beats of the pulse there should be a little more than one respiration. Let us now return to the subject of the shallow-bath operations, which gave rise to these calculations concerning the equilibrium of the pulse and respiration. It will be remembered, that in those operations the average rapidity of the pulse (as gained by calculations from those experi- ments only which also contained an account of the respi- ration) was before the process 82.21, and after the process 94 in the minute, that the breathing motion took place 24 times per minute before, and 29.64 times after the opera- tion. But in the first place, according to the analysis which has been made on the correct relation between pulse and breathing, or heart and lungs, 24 (standing for the res- SHALLOW-BATH OPERATIONS. 153 piration) will be too high for 82.21 (as the numerical re- presentative of the pulse.) For as 72.73 : 19.31 : : 82.21 : 21.82. There is a balance therefore of 2.18 in favour of the respiration. In the second place 29.64 will also be too high a rate of speed of the lungs for 94 beats of the pulse at the termination of the process, for as 72.73 : 19.31 : : 94 : 24.95. Again therefore there is a balance in favour of the respiration, but this time to the amount of 4.69. So that it manifests not only an increase of rapidity, but an increased increase of rapidity. As the earth has two motions, one round the sun, and the other on its own axis, so the respiration has been accelerated not only with the acceleration of pulse, but in proportion to the acceleration of pulse. Under other circumstances the original respira- tion before the process having been 24, that is 21.82+2.18, that subsequent to the process should be 27.13, that is 24.95+2.18. But its actual rate of speed being marked by an additional 2.51, viz. by 29.64 its augmented rapidity is as it were two-fold. And from what has been already said on this subject in all the preceding chapters the sani- tary effect of this is most evident. Besides the effect of the shallow-bath on the pulse and respiration it was considered a point of great interest to discover the amount of heat abstracted from the body, and communicated to the water. The author therefore endea- voured to throw some light upon this subject by means of the following experiments, duly providing of course that the quantity of water should always be the same, namely, 15 gallons, and that the duration of the bath should be the same, namely one minute and a half. These experi- ments were conducted during some of the operations that were last described. 154 DETAILS AND STATISTICS OF THE TEMPERATURE OF THE WATER. Before immersion. 6 7 8 9 10 11 12 13 14 15 16 65.00 deg. F. 42.50 41.00 39.75 39.50 42.00 51.00 53.00 53.00 55.00 53.00 60.75 48.50 52.00 48.00 49.25 After immersion, .. 66.00 deg. .. 45.00 „ .. 42.50 „ .. 41.30 „ .. 41.50 „ .. 44.00 „ . 52.00 „ .. 54.00 „ .. 55.50 „ .. 56.00 „ . 54.00 „ . 61.75 „ . 49.25 „ ,. 52.75 „ . 49.33 „ . 50.00 „ Total 16)— 793.25° F. 16)— 814.88° F. Average 49.57° F. Average 50.93° F. Having, as above, ascertained the average temperature of the water of the shallow-bath both before and after the process, it is easy to calculate the average elevation of temperature caused by contact with the body. 50.93 — 49.57=1.36, which may be taken therefore in this individual as the representative of the amount of caloric abstracted from his system at each operation. More will be said on this subject in another place. The second series of shallow-bath operations were per- formed by a man twenty-eight years old, weighing ten stones and a half, and of a decidedly phlegmatic, unimpres- sionable diathesis. The results guided by the peculiarity of temperament will be seen to differ in an important manner from the first series. They are as follows : — SHALLOW-BATH OPERATIONS. 155 SECOND SERIES OF OPERATIONS. Each bath lasting one minute and a half. Pulse before bath. Pulse after Resp. before Resp. after bath. bath. bath. 1 72 ... ... 72 9 86 ... ... 68 3 80 ... ... 72 4 84 ... ... 68 5 76 ... ... 68 6 76 ... ... 60 : 96 ... ... 84 8 84 ... ... 78 20 22 9 84 ... ... 72 22 30 10 100 ... ... 72 24 30 11 88 ... ... 84 22 28 12 96 ... ... 72 24 28 (The next six followed the dry-packing.) 13 70 ... ... 60 14 60 ... ... 60 17 17 15 60 ... ... 60 18 18 16 66 ... ... 60 17 21 17 64 ... ... 72 18 22 18 72 ... ... 72 ... • 22 24 (The next three followed the wet-packing. ) 19 46 ... ... 72 26 26 20 44 ... ... 56 20 28 21 44 ... ... 60 26 26 Totally opposed to the results of the first series of the shallow-bath operations, in the present series there is ex- hibited with certain exceptions a decided depression of the activity of the pulse. At the same time the speed of the respiratory movements does not merely remain unimpaired, but is actually considerably augmented. In reference to the pulse the exceptions just mentioned are three-fold. 156 DETAILS AND STATISTICS OF THE Firstly, in operations 1, 14, 15 and 18, the pulse continues unchanged. Secondly, in No. 17 there is an elevation of pulse. Now both these exceptions are clearly referrible to casualty. But the third exception is of so important and interesting a nature as to demand a further consideration. It occurs in operations 19, 20, and 21, in each of which there is an extensive acceleration manifested. At the very first view the uniformity and largeness of the augmenta- tion clearly demonstrate something more than mere chance at the root of the difference. And immediately that we investigate the matter, the a priori view is justified. Glancing his eye at those of the figures alluded to, which indicate the state of the pulse before the bath, the reader's attention will be at once struck at their extreme lowness. He will probably have thought that the human pulse could never reach so low a point as 44 without ex- tinguishing life — a supposition which, extremely natural as it was before, is now demonstrated to be incorrect. The next question then to be considered is, could such a pulse be natural, or compatible with perfect health ? Certainly not. It is a highly artificial state produced by artificial means, namely, the wet-sheet. But this question is of course fully discussed in the chapter devoted to that process. The only matter now to be discussed is con- cerning the uniform elevation of the pulse after leaving the wet-sheet, and taking the shallow-bath, in an indivi- dual whose pulse is lowered by the shallow-bath under other circumstances, that is when unpreceded by the wet- sheet. The cause of this elevation, after what has now been said about the extreme lowness of the pulse in these three cases, must be apparent. It is already as slow as it can be, consistently with the due discharge of the corpo- real functions. Any further retardation therefore might be attended with detrimental effects. So that being inca- pable of falling it must either rise or remain stationary. Now the present rate of speed being highly artificial and SHALLOW-BATH OPERATIONS. 157 unnatural, the result both to be expected and desired, is that it should rise, and assume more or less nearly its pris- tine rapidity. And this actually takes place, and an admi- rable provision of nature it is. The reason therefore for the third exception to the general rule (that of depression of the pulse in this series of operations, which are influenced no doubt by the tem- perament of the individual,) is so definite, and all-impor- tant, that in summing up as usual the averages of rapidity the author will not include the three last numbers apper- taining to the pulse. And as there may be some although unknown influence exerted by this arterial peculiarity upon the lungs, the accounts of the respiration correspond- ing to them will also be omitted. Before the author proceeds to figures, let him beg to remind the reader that the above operations were performed on a person in health, and that the above statements refer only to persons in health. Of course if the wet-sheet were prescribed to an invalid for the sake of reducing the pulse, as for example in an inflammatory disease, means would be taken to prevent a subsequent return to its for- mer height, till the inflammation should be subdued. Such means are ready to the hand of every hydropathist. To arrive at a knowledge of the average rapidity of the pulse both before and after the process in the second series of operations, let the calculations be made in the usual way by adding together the first eighteen sets of figures in the two first columns respectively, and dividing each result by 18. On doing so it will be found that the first column amounts to 1414, and 1414 ■— 18=78.55, which therefore represents the average rapidity of the pulse before the bath. The second column yields a total of 1254, and 1254 -f 18 =69.66, which accordingly describes the state of the pulse after the bath. Now 78.55—69.66=8.89. The pulse therefore sinks on an average 8.89 beats in the minute at every bath. 158 DETAILS AND STATISTICS OF THE The calculations for the respiration must be made by adding together separately the first ten numbers of the last two columns and dividing by 10. The third column will be seen to give 204 by addition, and 204 -r 10=20.40. The fourth column amounts to 240, and 240 -7- 10=24.00. These two results therefore represent the average rapidity of breathing, the first before, the last after, the operation. 24.00—20.40—3.60, so that while the pulse was lowered 8.89 degrees, the respiration increased by 3.60. To discover the amount of heat communicated to the water by his body the following experiments were per- formed with this individual, most of which were accom- plished during the operations that have just been detailed. The thermometer was allowed to remain in the water for a little while before the mercury was examined, to render the results as accurate as possible. TEMPERATURE OF THE WATER. Before immersion. After immersion. 1 46.00 deg. F. ... 2 42.50 3 43.50 4 43.00 5 43.00 6 43.00 7 42.00 8 41.50 9 43.50 10 39.75 11 39.50 12 42.00 13 43.00 14 42.50 15 42.50 16 42.00 17 49.75 48.50 deg . F. 45.00 a 46.00 )) 45.00 }) 44.00 j> 45.00 a 44.50 )t 43.00 >} 46.00 a 42.25 a 41.50 )) 44.50 a 45.00 }) 44.00 )f 43.75 >i 44.00 .«> 52.50 >> SHALLOW-BATH OPERATIONS. 159 Before immersion. After immersion. 18 .... .. 47.00 49.00 19 .... .. 50.75 52.75 20 .... . 52.50 54.50 21 .... .. 53.75 55.00 22 .... .. 54.75 56.00 23 .. 57.50 58.50 24 .... .. 47.50 49.00 Total 24)- -1092.75° F. 24)— 1139.25° F. Average 45.53° F. Average 47.46° F. The average temperature of the water both before and after the operation being ascertained as above it is easy to discover the relative elevation of the thermometer during each process. 47.46 — 45.53 — 1.93. This then is the ave- rage of twenty-four experiments. But it will be per- ceived that there is considerable irregularity in this matter, there sometimes being more than twice as much difference of temperature as at other times. The extremes will be found on letting the eye scan over the columns, to be one degree, and two and a half degrees of Fahrenheit's ther- mometer. Thus in experiments 1, 3, 9, 10 there will be seen two and a half degrees of difference between the two columns, whereas in No. 5 there is only one degree of dif- ference. On this subject more will be spoken in the analysis of the shallow-bath operations. The next and last series of operations with this bath were performed on the author of these pages. He thinks he may define his temperament as partaking of a mixed character, certainly not so excitable as he who underwent the first series, nor so phlegmatic as he who underwent the second. He proceeds to place them before the reader as follows : — 1G0 DETAILS AND STATISTICS OF THE THIRD SERIES OF OPERATIONS. Each bath lasting one minute and a half. Pulse before Pulse after Resp. before Resp. after bath. bath. bath. bath. 1 , 72 12 2 68 12 S 70 84 4 72 80 ,5 80 74 6 70 70 7 80 64 8 64 72 9 70 80 .. .... 14 . 24 10 70 84 .. .... 16 . 24 11 72 84 .. .... 18 . 24 12 72 84 .. .... 16 . 28 13 76 72 .. .... 18 . 24 14 80 76 .. .... 18 . 22 15 80 96 .. .... 18 . 28 16 68 72 .. .... 17 . 24 Out of these sixteen experiments it will be perceived that the pulse fell four times, was stationary twice, and became augmented the remaining ten times. Of the eight experi- ments on the respiration that function was accelerated on every occasion. The reader will now perceive clearly the different effects of the shallow bath produced according to the different temperament or constitution of the individual. In the present series the pulse fell 4 times in 16, that is 1 in 4, the author's disposition being neither excitable nor phleg- matic. In the first series, the bather being of an excitable constitution, the pulse fell only once in 18 operations. In the second, where the person was of a decidedly phlegmatic mould, the pulse fell habitually. Let the figures of the first column be added together, THE SHALLOW-BATH OPERATIONS. 161 and they will be found to amount to 1164, and this divided by the number of times the experiment was performed will give a result that shall indicate the average rapidity of the pulse before the process. 1164-f- 16 =72.75. The second column treated in the same way will discover the average state of the pulse after the process. The total amount of the figures is 1236, and 1236 -f- 16 = 77.25. And 77.25 — 72.75=4.50, which is the average elevation of the pulse in this series of operations, and which, in accord- ance with what has already been said about the temperature of the bather, will be recognised as a moderate rise, and on contrasting the results of this with the first and second series of operations, will be found to represent a due medium between the latter two. More will be said on this subject presently. The first column of figures referring to the respiration yields a total of 135, and 135 -f- 8=16.87, which represents the average number of respirations per minute before the bath. The last column amounts to 198, and 198-7-8 = 24.75, which is the number of respiratory movements after the bath. Now 24.75—16.87=7.88. Such, then, is the average increase of breathing. But it will be seen, although in this series of operations the pulse fluctuated considerably, and yielded a total rise of only 4.50 beats, the respiration manifested an uniform ascent and displayed an average on the total of 7.88, which (according to some recently described statistical calculations, whereby it was shewn that one res^ piration corresponded to 3.76 beats of the pulse) is virtually equivalent to between 29 and 30 arterial pulsations, and would be sufficient to counterbalance such an augmentation. With this person also were performed some experiments on the temperature of the water. They are here detailed. 162 EFFECT OF THE SHALLOW-BATH ON THE PULSE. TEMPEEATUEE OP THE WATER Before immersion. After immersion. 1 47.00 deg. F 48.00 deg 2 48.00 , 50.00 3 48.00 , 50.00 4 41.00 , 43.00 5 . ..... 43.00 , 45.00 6 . 44.00 , 46.00 7 . 42.00 , 44.00 8 . 44.00 , 45.50 9 . 42.00 , 44.00 . 43.00 , 45.00 1 . 44.50 , 46.50 2 . 46.00 , 48.00 3 . 47.00 , 49.00 13)579.50° F. total. 13)604.00° F. total. 44.57° F. average. 46.46° F. average. 46.46 — 44.57 = 1.89. This, therefore, is the average thermometric rise for each bath. As, however, in the experiments on temperature previously detailed, so also in these there is considerable fluctuation in the individual processes. The greatest difference between the heat before immersion and that after it is two degrees on Fahrenheit's scale, and the smallest is one degree. For examples, see the first and second experiments. Analysis of the Shallow-Bath Operations. The general effect of the first series of operations upon the pulse was to accelerate it by 11.17 beats in the minute. That of the second series was to diminish its frequency by 8.89 beats in the minute. In the third the pulse was quick- ened three times, and retarded once, in every four. What is the cause of this difference ? It has been most satisfac- torily explained on the score of variety of temperament. JTS EFFECT UPON THE RESPIRATION. 163 The pulse of the excitable temperament is excited, that of the phlegmatic one is depressed, that of the neither excita- ble nor phlegmatic one is neither wholly excited nor wholly depressed. But it is more frequently excited (namely, three times as often) than depressed. It may, therefore, be considered that, where temperament does not interfere either one way or the other, the more general effect of the shallow bath is to accelerate the pulse. Its 'physiological action is that of a stimulant. In all three series of operations its influence upon the respiration is constant. It invariably promotes the rapidity of that function, not only actually, but also in proportion to the increased activity of the pulse. It consequently exercises that salutary effect in the purification of the blood, which has received so much and so well-merited attention throughout this book. By promoting the respira- tory process, it increases the quantity of air, and therefore the quantity of oxygen taken into the lungs. This gas is ad- mitted into the air cells in greater abundance, in proportion to the amount of blood admitted, than is usual. A larger quantity of air being thereby devoted to the decarboniza- tion of the same quantity of blood, that fluid is aerated, is oxygenated much more efficiently than before. And from the improvement thus effected in the quality of the blood flows incredible benefit to the general health of the system. For a few detailed advantages, let the reader refer to the introductory chapter. It will be observed that in the first series of operations the rate of speed of the pulse prior to the commencement of the process did not at all affect its accelerating influ- ence. Whether the pulse had been previously excited by exercise, or had been retarded by the horizontal position in the blanket-packing, or had been still further lowered by the depressing action of the wet-sheet, it makes no differ- ence in the fact of its receiving increased rapidity from the employment of the shallow-bath. And with regard to the respiration precisely the same thing occurs. 164 ANALYSIS OF THE SHALLOW- BATH OPEEATIONS. In the second series, where the general effect of the shallow-bath upon the pulse is lowering, the blanket-pack- ing interferes with this result to a considerable extent, but the wet-sheet altogether subverts the rule. In the three experiments, where the process last mentioned preceded the shallow-bath, the pulse was thereby brought to so low a degree before immersion in the water, that it would not have been practicable without danger for it to fall still lower. Nay more, it would not have been unprejudicial to health for it to continue for any length of time as low as it then was. Consequently nature made an exception in this case to her general rule. Sooner than permit the probability of detriment occurring to the system, she al- tered her policy and allowed the pulse, not merely to re- main stationary, that is undepressed, but even to ascend* The same rationale will explain the same thing, which ap- pears in a modified degree to follow the blanket-packing. In the three last experiments of the same series the res- piration will be seen to be twice stationary and once raised. Now the reader might possibly imagine that it must be very odd that, after all that has been said about the har- monious relation between the .circulation and the respira- tion, the latter in two instances does not ascend in accord- ance with the former, which rises about twenty beats in the minute. And yet the reason that the respiration is in these cases unaffected is most obvious. By drawing a comparison the reader will immediately perceive that the figures denoting the velocity of the breathing process are not only not low, but are even very high, both in propor- tion to the condition of the pulse before it is elevated, and also in proportion to its increased rapidity. 26 to denomi- nate the activity of the respiratory process is far more than equivalent to 60, or 72 as denoting the state of- the pulse after the shallow-bath in the two experiments. It was therefore of course quite unnecessary for the respiration, to be accelerated under the circumstances. REASONS FOR THERMOMETRY EXPERIMENTS. 165 It will be noticed that, for the simplicity of the subject, the author has been somewhat elaborate in his thermome- tric experiments upon this bath. But he conceives that in this matter he can produce reasons sufficient for his justi- fication. He commenced his investigation into the change of temperature effected in the water by the immersed body with a two-fold object. One was the same, that actuated him equally in all his researches, namely to elicit any fact, that might rise to the surface, no matter as yet whether of vital interest, or comparatively unimportant, knowing as he does that the establishment of a simple, and at first to all appearance uninteresting fact, not unfrequently lays the foundation for the erection by and by of a stupendous su- perstructure. The second object he held in view, although neither, in his opinion, more definite, nor to the philosophi- cally enquiring disposition more important in its nature, still was one, that in point of time concerned us more nearly. He thought he descried through the vista of hy- dropathic ignorance (and as yet our knowledge of the sub- ject, as in the future by a retrospective glance we shall find it to be, is extremely limited) he thought he descried an easy method by means of the thermometer of testing the constitutional powers of an individual. The immense ad- vantage of gaining such information by a simple contriv- ance need not be dwelt upon. It could not be exaggerated. He expected it would be demonstrated that the greater a person's vigor of constitution, the greater impression would be made upon the temperature of the water. For if the various animal functions be conducted in a tolerably healthy manner, as the most, or one of the most important of them all is the generation of heat, this product, if by any means it should be more than usually abstracted from the body, would be the more readily re-supplied. The author therefore founded his theory upon this. Let a man be placed in a shallow-bath. So much animal heat is transferred from his bodv to the water. Now if his con- 166 ANALYSIS OF THE SHALLOW-BATH OPEEATIONS. stitutional power be vigorous, fresh caloric is immediately generated — the body becomes as warm as it was before — and so more heat is transferred to the water. But if his vital powers be much impaired, the loss of heat sustained by contact with the water is not easily replaced. The body does not become so warm as before. More heat is not transferred to the water. And the temperature of this fluid therefore should not rise in the same proportion as in the first suppositious case. To obviate fallacy in the re- sults of course it would be necessary to have corrective rules relating to the weight, and perhaps temperament of the individual. The existence or non-existence of febrile excitement, that is the presence of morbidly abundant heat of surface, must also be taken into account. This object, although still in the distance, and still in- distinct, nevertheless still arrests his attention, and one day he hopes to grasp it. But alas ! he soon found that to arrive at the wished-for point, and confirm his surmises, a vast number of experiments would be necessary. And it was needful not only that the experiments should be manifold, but that they should be performed on many and all sorts of individuals. He knew therefore that his own unaided efforts would be valueless. But he hoped that they would not be unaided; on the contrary that they would form a nucleus for the developement of a number of others by philosophically enterprising hydropathists. Ex- periments of a novel nature, and in a new field always require an immense amount of thought for the designing, and an immense amount of patience and industry for the carrying-out. It is not always therefore, as it always ought to be, that actual experiment, scientific experimental re- search by rule and measure, occupies the first consideration of those who adopt any novel practice. For this reason the author thought he should commence the thermometric experiments upon the shallow-bath, not that unsupported they would possess interest, but that they would be of RESULTS OF THERMOMETRY EXPERIMENTS. 107 great value, if they were the means of exciting others to do likewise. In this way, when the results of the labors of others, emulous in the race of knowledge, should be known, and comparative estimates made of the whole, great scientific truths would be established. And when once he determined to commence this series of investiga- tions, he resolved of course that this commencement should be as complete as it was in his power to make it. Hence then the comparatively, but not unfitly elaborate tables presented to the reader. Nor would it have been suffi- cient, as some persons may suppose, to have described the averages only, the quotients of the sums, without the in- sertion of the details. For in such case the justly criti- cal reader would ask, " What is this average ? How do we know it is correct ? Where are the figures to prove its accuracy ? It is a mere statement." In private life we believe every man, till he is convicted of a lie. But in science and philosophy the author himself credits nothing but what is demonstrated. Especially in the establish- ment of a new doctrine, or new practice, proof, absolute proof is indispensable. He contents himself therefore with merely stating the following facts. As the average result of many operations fifteen gallons of water were raised in temperature during the period of one minute and a half by the immersed body of a man of sanguine temperament from 49.57° F. to 50.93° F., by one of phleg- matic temperament from 45.53° F. to 47.46° F., by one whose temperament is neither the one nor the other from 44.57° F. to 46.46° F. The elevation in the first instance amounted to 1.36° F., in the second to 1.93° F., and in the third to 1.89° F. An average deduced from these three estimates would yield for every operation 1.72° F. About one degree and three quarters may therefore be considered to represent the usual elevation of temperature. CHAPTEE VI. THE S1TZ BATH. The first series of operations were undergone by a man weighing about ten stones and a half, and about twenty eight years of age. In every experiment there were about four gallons of water employed. FIRST SERIES OF OPERATIONS. OPERATION I. Pulse. Resp. Temperature of the water. Before the process 100 . 20 .. .... 43.00 deg.F. After 5 minutes... 72 . 20 .. .... 45.00 After 10 minutes.. 72 . 22 .. .... 49.00 After 15 minutes.. 72 . 20 .. .... 50.00 OPERATION II. Pulse. Resp. Temperature of the water. Before the process 86 ... ... 19.5 . 43.00 deg. F. After 5 minutes... 64 ... ... 20 . 45.33 After 10 minutes.. 64 ... ... 20 . 50.75 After 15 minutes.. 64 ... ... 20 ., 50.75 OPERATION III. Pulse. Resp. Temperature of the water. Before the process 72 ., 19 .. .... 42.50 deg. F. After 5 minutes. . . 57 .. .... 21 .. .... 45.75 After 10 minutes . 54 . 21 .. .... 48.25 After 15 minutes. 56 . 20 .. .... 50.50 „ DETAILS OF THE SITZ-BATH OPERATIONS. 169 OPERATION IV. Temperature Pulse. Resp. of the water. Before the process 66 20 43.00 deg. F. After 5 minutes... 64 20 48.00 After 10 minutes 60 20 49.50 After 15 minutes 60 19.5 51.33 OPERATION V. temperature Pulse. Resp. of the water. Before the process 72 18 42.50 deg. F. After 5 minutes... 54 19 45.50 „ After 10 minutes 54 19.5 48.50 After 15 minutes 51.5 ... 20 50.00 OPERATION VI. Temperature Pulse. Resp. of the water. Before the process 68 ...... 20 44.00 deg. F. After 5 minutes... 52 19 48.75 „ After 10 minutes 54 17 51.00 After 15 minutes 51 18 52.00 , ? The second series of operations, which here follow, all lasted for half an hour, and were performed on the same individual as the first. SECOND SERIES OF OPERATIONS. OPERATION I. Temperature Pulse. Resp. of the water. Before the process 76 19 43.33 deg. F. After 5 minutes... 64 20 47.33 After 10 minutes 56 18 49.75 ?> After 15 minutes 55 18 50.50 After 30 minutes 52 18 53.33 z 170 DETAILS OF THE OPERATION II. Temperature Pulse. Resp. of the water. Before the process 72 20 ...... 42.50 deg. F. After 5 minutes... 62 20 46.00 After 10 minutes 56 20 48.50 After 15 minutes 52 20 51.50 After 30 minutes 46 18 53.25 OPERATION III. Temperature Pulse. Resp. of the water. Before the process 71 19 42.00 deg. F. After 5 minutes... 52 20 46.50 After 10 minutes 47 16 46.50 After 15 minutes 47 18 49.00 After 30 minutes 42 18 54.00 The third series were performed by the author upon himself. THIRD SEEIES OF OPERATIONS. Each of fifteen minutes duration. OPERATION I. Temperature Pulse. Eesp. of the water. Before the process 72 18 ...... 49.50 deg. F. After 5 minutes... 60 16 53.50 After 10 minutes 56 19 54.00 After 15 minutes 57 19 54.00 OPERATION II. Temperature Pulse. Resp. of the water. Before the process 59 17 49.50 deg. F. After 5 minutes... 59 16 54.00 After 10 minutes 59 15 54.00 After 15 minutes 56 ...... 19 55.00 SITZ-BATH OPERATIONS. 171 OPERATION III. Temperature Pulse. Resp. of the water. Before the process 72 16.5 50.00 deg. F. After 5 minutes... 50 15 54.00 „ After 10 minutes 49 17 55.00 After 15 minutes 50 16 55.00 OPERATION IV. Temperature Pulse. Resp. of the water. Before the process 60 16.5 52.00 deg. F. After 5 minutes... 53 16.5 56.00 After 10 minutes 52 15.5 57.00 After 15 minutes 52 16 58.00 OPERATION V. Temperature Pulse. Resp. of the water. Before the process 60 15.5 53.00 deg. F. After 5 minutes... 52 15 57.50 „ After 10 minutes 52 15.5 58.50 „ After 15 minutes 51 16.5 59.00 Analysis of the Sitz Operations. The first two series of experiments were performed upon a man of phlegmatic temperament, the third one upon the author, whose temperament is, if he himself can be said to be a judge, neither phlegmatic nor sanguine. It certainly, however, if it incline to either kind in particular, partakes more of the latter character than of the former. At all events, the two sets of operations should be considered first separately. Let us begin, then, with the first two series, and it will be found that these two series embrace a sequence of nine experiments. By adding together the figures representing the state of the pulse before the commencement of the process in each of these experiments, and dividing the result by nine, it will be discovered that the average pulse previous to immer- sion in the bath was 75.88 beats per minute^ By perform- 172 ANALYSIS OF THE SITZ-BATH OI^EBATIONS. ing the same calculation with regard to the figures second in the column, the rapidity of the pulse, after five minutes' immersion, will be ascertained to be 60.11 beats per minute. In the same way, the pulse, after the expiration of ten minutes passed in the bath, will be found to present an average of 57.44, and after fifteen minutes 56.50. It will be observed, therefore, that the first five minutes' immersion caused a subsidence of the pulse of 15.77 beats, that of the second five minutes a further diminution of 2.67, and that of the third five minutes a still further diminution of $£> of a beat. Hence, then, the sitz bath of a quarter of an hour's du- ration exercises a constantly depressing effect upon the pulse. That depression is the most marked within the first few minutes from the commencement of the bath, and becomes less and less so towards its conclusion. Now the first six of these nine experiments endured only a quarter of an hour, but the three last continued for thirty minutes. Let us see,, therefore, what difference in the pulse the additional fifteen minutes effected. The average number of pulsations at the expiration of the half-hour, drawn from calculating the three baths of that duration, will be seen to be 46.66. This would seem to indicate a fall of nearly ten beats, for 56.50 was the last average calculated, namely, that one representing the state of the pulse after fifteen minutes' immersion. But this computation requires correction. To make it as far as possible exact, it is necessary to deduce an average for fifteen minutes from the same baths, and those only, whence has been deduced the average pulse for thirty minutes. And on making this correction, a considerable alteration will result. The average rapidity of the pulse, at the termination of fifteen minutes' immersion in the sitz- bath, derived from a calculation of the operations of the second series only, is 51.33. The fall, therefore, at the end of the half-hour, is not from 56.50, but from 51.33 to 46.66. So that there is a depression merely of 4,67, and not as according to the first computation, of nearly ten pulsations. THEIR EFFECT UPON THE PULSE AND RESPIRATION. 173 Let us now cast an eye upon the effect produced by the sitz-baths of these two series on the process of respiration. By making precisely the same calculations, as were made in reference to the pulse, the average number of respira- tions will be discovered, as follows : — before the process, 19.39 per minute, — after five minutes' immersion, 19.77, — after ten minutes, 19.27, — after fifteen minutes, 19.27. It will be at once perceived that these different periods pro- duce numerical alterations only in fractional quantities. Indeed it may be fairly said that hitherto the rapidity of respiration has been unaffected. But at the expiration of the half-hour the figures intimate an average of 18 respi- rations in the minute. If, however, we now inquire into what the medium speed of the breathing process was in the three operations of the second series, (namely, those only which were prolonged for thirty minutes), we shall perceive it to have been 18.66. Here then again appears a mere decimal alteration, the fall being sixty-six hundredths of a respiration in the minute. To repeat, then, we may fairly consider that while the pulse subsided from 75.88 to 46.66 (a fall of nearly thirty beats! — of % of its original number ! ) , the respiration was unaffected. No wonder the head is not congested by the sitz-bath ! No wonder that, as will pre- sently be explained, contrary to all preconceived opinions, it relieves headache, and sometimes cures it like a charm ! Hitherto we have considered the influence of the sitz- bath upon the respiration and circulation in the case of an individual of a phlegmatic temperament. Let us now turn to one of an intermediate constitutional disposition, neither very phlegmatic nor very sanguine, and see if the difference of temperament will caUse the appearance of a difference in the results of the experiments. In the third series of operations the average rapidity of the pulse, ascertained in the usual manner, will disclose itself as follows : — before the commencement of the process, 64.60 beats in the minute. — (The observant reader will here think he has 174 EFFECT OF THE SITZ UPON THE RESPIRATION, caught the author tripping. He will remember to have seen an opinion of the latter, expressed in the beginning of the work, to the effect that one sign of a phlegmatic temperament was an habitually slow pulse. And yet here is a gentleman, who puts himself down as rather more in- clining to the sanguine than to the phlegmatic disposition, but whose pulse, at the onset of the experiment, is abso- lutely considerably less frequent than that of him who un- derwent the two preceding series of operations, and who displayed the phlegmatic temperament in perfection. This apparently embarrassing contrariety, however, is to be ex- plained away in the most simple manner in the world. The author never took exercise before his baths; the other did invariably.) — after the expiration of five minutes' immer- sion, 54.80, — after ten minutes, 53.60, — after fifteen mi- nutes, 53.20. The first five minutes, therefore, caused a subsidence of ten beats within two-tenths ; the second a further diminution of 1.2, and the third a still further re- duction of .4. What a strong resemblance is here made manifest between the results of this series, and of the two last. It is true that in the' latter the pulse had fallen more than fifteen beats in five minutes, but then the original pulse had been nearly 76, whereas in this series it is only 64. It could, so to speak, afford to fall more considerably. And accordingly it did fall 15.77 beats, while in the present series of operations it falls in the quarter of an hour just 11.40 pulsations. Let us now examine the condition of the breathing ap- paratus in this set of experiments. It will be discovered that the average rapidity of the respiratory process for each operation, as deduced from the five of the series, is as fol- lows : — before the process 16.70, — after five minutes 15.70, — after ten minutes 16.40, — after fifteen minutes 17.30. From these facts it will appear that, while the pulse was sinking ten beats, the respiratory process abated just one movement, and that, while the pulse continued to lose in, PULSE, AND TEMPEEATURE OF THE SKIN. 175 rapidity to the end of the process, the respiration began to increase in rapidity at the conclusion of the first five mi- nutes and went on without interruption, increasing for the remainder of the fifteen minutes. It will now be the correct moment to make inquiry into the effect upon the temperature of the water in the sitz- bath, produced by the immersion of the body. The ave- rage temperature of the bath, derived from a calculation upon the nine operations of the first and second series, is the following : — before the commencement of the process, 42.87° F.— after the lapse of five minutes 46.46° F.— after ten minutes 49.08° F.— after fifteen minutes 50.62° F.— and after thirty minutes 53.52° F. But if we calculate the average height of the thermometer at the end of fifteen minutes from the three last operations, (namely, those which endured for half an hour), we shall find it to be 50.33, instead of 50.62. And this must be done before it can be accurately laid down, as to how great an elevation of the thermometer took place between the expiration of fifteen and of thirty minutes. Now it can be stated safely that the temperature was elevated in five minutes from the period of immersion 3.59° F., in ten minutes was further elevated 2.62° F., in fifteen minutes still further 1.54° F., and in thirty minutes an additional 3.19° F., that is about one degree for every five minutes, but beyond a question considerably more for the first five minutes than for the last of the fifteen. In the operations performed upon the author the thermometric results were these : — average tem- perature of the water before the immersion of the body 50.80° F, after five minutes 55.00° F., after ten minutes 55.70° F., after fifteen minutes 56.20° F. It will be as well now to arrange a statistical table, embracing the ave- rage condition of pulse, respiration, and temperature of the water computed from a combination of these two analyses, in other words, from a combination of all three series of operations. 1 70 the sitz in congestion of the brain. Statistics of the Sitz-Bath. Average Average Average Temperature Pulse. Respiration. of the water. Before the process. 70.24 18.04 46.83 deg. F. After 5 minutes... 57.45 17.73 50.73 „ After 10 minutes.. 55.52 17.83 52.39 „ After 15 minutes.. 54.85 18.28 53.41 „ After 30 minutes.. 50.18 17.44 56.60 „ This table will represent as accurately as possible the gene- ral effect of a sitz-bath of five, ten, fifteen, or thirty minutes' duration. The reader may perhaps wonder how the last figures, namely those indicating the different ave- rages at the expiration of thirty minutes, were obtained. If he will turn back to the description of the various move- ments of the pulse in the second series of operations, he will there find a calculation shewing that in the last half of a bath of thirty minutes' duration the pulsation of the heart subsided 4.67 beats. Now, if 4.67 be subtracted from 54.85, the average pulse given above as existing at the ter- mination of fifteen minutes, the next number, 50.18, will be the result obtained. So with regard to the respiration and temperature. By referring to the analysis of the second series the reader may verify these statements, or rather figures, for himself. It maybe considered established therefore, that the sitz- bath greatly depresses the pulse, and leaves the respiration as nearly as may be unaffected, for, while the pulse falls more than 20 beats in the minute, the breathing drops only ! 6 of a respiratory movement. Which diminution of the celerity of the pulse, and non-diminution of the respiratory process it is, that imparts to the sitz-bath its excellent pro- perty of dissipating headache, that is to say, headache com- monly ascribed to determination of blood to the brain, or congestion of that organ. This affection is generally sup- posed to yield to the bath under discussion in consequence ITS MODE OF OPERATION. 177 of the latter's derivative operation. Its disappearance is as- cribed to the determination of blood from the head to the parts immersed in water. And the argument adduced in support of this theory is the fact, that those parts are red- dened by the process, indicating the presence of more blood circulating through the skin than previously. This is perfectly true, as far as it goes. But it is not enough. The author has known severe head-symptoms, as consider- able torpor, muscae volitantes, dimness of sight, &c, relieved by the sitz without altering the natural pallor of the skin in the slightest degree. He has also known a head-ache vanish almost in the act of sitting down in the water, and therefore before it was possible the integument could de- rive into its own capillaries the blood previously congesting the vessels of the brain. Pie mentioned before that a pa- tient of his laboring under extensive disease of the lungs, (the result of an asthma of forty years' standing,) with considerable head complication never had his respiration more free, nor his brain more unclouded than in the sitz- bath. And yet this gentleman's skin was not at all red- dened by the water, although the latter was of the natural temperature. The mode in which the author believes, (and surely his belief is grounded on substantial data, the most substantial of all, actual experiments ,) the mode in which the sitz bath exercises what is called its beneficial derivative effect, is njt really so much by derivation of blood, as by purification of that fluid. One word in ex- planation will not be thrown away. A person is afflicted with headache arising from congestion of the brain. At least he is told that this is the origin of his malady. He is assured that the brain is congested, that is, that the ve- nous capillaries of that organ are distended, and contain more blood than they would in their normal condition, and that this superabundance of blood by the pressure upon contiguous parts gives rise to the symptoms, that have de- clared themselves. These symptoms, from the etymological 2 A 178 THE TRUE PATHOLOGY OF signification of the word, should be the external manifesta- tions of some definite internal disease. But they are not. They merely shew that there is something wrong with the brain. What that something is, they do not demon- strate. Now let us inquire into the nature of* those symp- toms of congestion of the brain. And we shall find them to be something like the following : — impaired memory ; confusion of ideas ; incapability of sustaining the attention ; deterioration of some one or more of the organs of special sensation, especially of sight or hearing ; increased nervous sensibility, both general and local, the first displayed in what is called "nervousness," the second in neuralgic pains, or spasmodic affections ; deficient nervous sensibility, evi- denced by dullness of intellect, and muscular weakness, or paralysis ; perverted nervous sensibility, made manifest by the production of unnatural sensations, as of water trick- ling down the spine, or ants creeping over the skin, or by erroneous impressions made upon the nerves of special sense, as in the seeing of silvery stars, black specks, clouds, and floating insects invisible to other eyes, or in recognising sounds unheard by other ears, or in the perception of odors, which other noses cannot appreciate ; lastly pains in the head of various kinds and intensity, from a heavy dull weight to the feeling of a knife passing through the brain, or of a nail being driven into the skull. When these symptoms are more or less aggregated together, and their origin can be traced to too intense application to busi- ness, or to too close study ; and when there is no reason to apprehend the presence of any more serious disease, as inflammatory congestion of the brain, or actual inflamma- tion of that organ, or the growth of a tumor ; and espe- cially when they are associated with marked disturbance of the digestive viscera, they are at once said to indicate the existence of chronic or venous congestion of the head. But it has been said that they really indicate merely some disordered condition of the brain. That disordered condi- CONGESTION OF THE BRAIN. 179 tiou, from the absence of actual inflammation, tumor, and so forth, is presumed to be congestion. But precisely the same symptoms are generated by too little blood, or by a vitiated state of that fluid. The former we see verified every day in 'those pale-faced, chlorotic girls, that we en- counter at every turn in the street, and whose waxy com- plexions betray at once their complaint, and their blood- lessness as its cause. The latter is observed with equal clearness in different kinds of poisoning. What then is the direct evidence of the presence of congestion, that is, of capillaries distended with superabundant blood in cases characterized by the foregoing symptoms ? There is abso- lutely none ; no flushing of the face ; no preternatural heat of the head ; it may be according to the patient's perver- ted sensations abnormally hot, but not thermometrically, not appreciably to the hand of another individual ; should the patient die, there are no post mortem appearances to warrant this supposition ; at the inspection no distended capillaries, no superfluous quantity of blood are revealed to vision ; but the substance of the brain is observed to be pre- ternaturally dark, and this depends upon the fact of the blood contained therein being too dark, in other words too venous. Of such cases therefore as these, where the pa- tient is said to labour under congestion of the brain, and dyspepsia, the author has conceived an opinion, differing from the received theory, but which is at once simple, defi- nite, and most easily explained. The more he reflects upon it, and the more he sees of the disease under discus- sion, and the more he observes the effects of hydropathy, and particularly of the sitz bath upon that disease, the more does he become convinced of its truthful foundation. He has already shewn what a powerful and deleterious effect close confinement and sedentary habits exert upon the process of respiration. He has shown how this all- important, and most vital of all vital functions is thereby impeded in its duty, — how this impediment is inevitably 180 CONGESTION OF THE BEAIN AND DYSPEPSIA. followed by the insufficient aeration of the blood in the pulmonary tissue, — how in consequence of this the expul- sion through the air cells of the lungs of its carbonacious particles is imperfectly effected, and that thereby it retains certain noxious qualities characteristic of its previously venous, or impure condition, — how in this impure, unarte- rialized state it flows through the lungs into the arteries, and is by them distributed to every part of the body, — and how, by thus flowing into the various tissues, it is capa- ble of generating, and does generate disease in those tissues. And this is precisely the author's view of the so- called " congestion of the brain" and "dyspepsia." He believes that they are neither of them local affections, — that neither the head, the stomach, nor the liver is more at fault than any other part of the frame, — that in such cases the whole system from the crown of the head to the sole of the foot is poisoned by the circulation of impure, unde- carbonized blood. It is impure blood circulating through the brain, that gives rise to the brain symptoms. It is im- pure blood traversing the stomach, bowels, and liver, that gives rise to the stomach, bowel, and liver symptoms. It is impure blood supplying the substance of the muscles, that gives rise to the muscular debility. In short impure blood travels to every tissue, and every tissue suffers in consequence. Does not the invalid labouring under this malady, complicated in its catalogue of symptoms, yet simple in its origin, invariably tell you that he has not a healthy organ in his body, and that there is no part of his frame, wherein he does not sometimes suffer ? Adopting then this simple view of the disease in question, how easy is it to understand the beneficial influence it derives from the use of the sitz-bath ! Let a person be supposed to endure that series of symytoms which are attributed to congestion of the brain, but which the author has endea- voured to prove would more correctly be ascribed to the circulation in the brain of impure blood, blood imperfectly ACTION OF THE STTZ-BATH IN THESE DISEASES. 181 decarbonized. Let him be placed in a sitz-bath. His pulse immediately commences diminishing in frequency, as may be seen by consulting the foregoing experiments. His respiratory function remains unaffected. A less quantity of blood therefore than usual meets the usual quantity of air, which consequently performs its purifying duties in a more efficient manner. For example, one respiration being generally achieved in the same time as 3.76 pulsations of the heart, (see experiments on this subject detailed in the chapter on the shallow-bath,) and one pint of air being in- haled at each respiration, it follows, if the pulse beat less frequently than in accordance with this proportion, and the rapidity of the respiration remain unaltered, there will not be sufficient blood pumped by the heart into the lungs to employ all the air inhaled. But if the blood circu- lating in the system be impure from imperfect decar- bonization, this superabundance of air in the lungs is the very thing to cure it. And, by creating this super- abundance of air in the lungs, the sitz-bath does cure it. It cures this general circulation and distribution of impure, undecarbonized blood. And as this impurity of the circulating fluid tells more powerfully upon the delicate tissue of the brain than upon any other organ, thereby developing cerebral symptoms more prominently than any other, in the same ratio is the beneficial influence of the sitz-bath, and indeed other hydropathic appliances, in the reduction of these symptoms, more particularly striking. Now let not the author be misunderstood. He does not for a moment deny the derivative action of the sitz-bath. But he does maintain that this derivative action is far from being its principal physiological effect. And to support this opinion he believes he has now brought for- ward sufficient evidence. By reference to the statistical table of the sitz-bath the reader will observe the very definite ratio in which heat is transferred from the bodv to the water. Now it will be 182 THE VALUE OF EXPERIMENTS. immediately admitted, that the most tonic agent known is the application of cold, that is, the withdrawal of heat, just as the latter imponderable is the universal relaxing agent. The sitz-bath therefore agrees with most other hydropathic appliances, in being an excellent tonic. The author begs here to draw the reader's attention to the fact, that great results and important inferences may follow apparently aimless experiments. As he has before mentioned, he instituted most of his experiments without any notion as to whither they would lead, and without the slightest intention of arriving at any particular result. He merely emptied his well to see if any truth, no matter of what kind, lay there concealed. He aimed at any in- formation, that he might happen to find in his search. And seeing in the thermometer a likely path to pick up a little knowledge, or a few facts, he at once struck into it. Nor has his search in this direction, with reference to the sitz-bath, been without success. He has proved beyond a doubt, many useful things. For example he has shewn (see statistics of sitz-bath) that in a bath of fifteen minutes' duration more animal heat is abstracted during the first third than during the last two thirds of the operation, and therefore that two sitz-haths of five minutes' continuance possess more tonic power than one bath of fifteen minutes' duration. The thinking reader will be able to deduce many such important inferences through the whole of the work, which the author has not space to do for him. The book is already prolonged beyond his original design. There is one class of affections, where the sitz-bath, administered in a peculiar way, has been found by the author to be of essential service. And this class is so common, so lamentably common, and so steadily increasing, that even a page or two devoted to its consideration will not be thrown away. The disorders alluded to are those connected with functional derangement of the womb, in- dicated by some disturbance of the menstrual secretion. DISORDERED MENSTRUATION AND LEUCORRHCEA. 183 This disturbance may be exhibited in very many shapes. There may be retention of the menses, that is, the discharge may never have appeared, the proper age for its appearance having elapsed. Or there may be suppression of the menses, that is, the function, having been correctly dis- charged on previous occasions, shall have ceased to be so discharged. The secretion, regular in its periodic arrival, may be too scanty in quantity, or too abundant, constitut- ing deficient, or profuse menstruation. Lastly, the men- strual product, normal in its period of advent, and accurate in its quantity, may be elaborated from the womb with great difficulty and suffering. But under whatever phase, or external manifestations this functional disarrangement of the uterine system may shew itself, it is nearly always accompanied by a leucorrhoeal discharge, commonly known by the appellation of " the whites." And on the other hand the author will venture to assert with confidence from his own experience alone (although that of all the profes- sion is in accordance, he believes, with his), that a leu- corrhoeal discharge, although more or less present in almost every woman who has been unwell for some time, is never unattended by strongly marked symptoms of uterine dis- turbance. (When he was a student at Guy's Hospital he was what is called " dresser," or " clinical clerk " to a ward appropriated to diseases of the womb alone. He had, therefore, peculiar opportunities of entering into the details of this class of cases, and investigating them thoroughly.) Indeed, in certain old-standing complaints of this nature there appears, as it seems to him, to be a kind of supplementary action between the leucorrhoeal, or white, and the menstrual, or red, discharge. On these occasions the amount of the one secretion appears to bear an inverse ratio to that of the other. As the menstrual discharge increases in quantity, the leucorrhoeal one diminishes, and as the former is diminished, the latter is augmented. Now, if some menstrual fluid be submitted to a chemical 184 DESCRIPTION OF A YOUNG LADY IN HEALTH, and microscopical analysis, it will be found to contain all the ingredients of blood, with the exception of the self- coagulating substance, flbrine. It will be seen to be com- posed of red globules, albumen or white of egg, certain mineral salts, and water. If then, some leucorrhoeal matter be investigated in a similar manner, it will reveal certain white globules, albumen, salts, and water. Here then it will be discovered, that these two apparently dissimilar fluids resemble each other in every particular, but in the nature of the globules contained. In the one case they are the red globules of the blood, in the other the white globules of mucus, or pus, accordingly as the leuchorrhceal discharge may display a mucous or purulent character. It will be easily perceived, therefore, how readily, cceteris paribus, the two secretions may be substituted for each other. Now let us summon to our aid a supposititious case. A young lady goes to a ball. Before she goes, she is per- fectly well, that is to say, as well as most young ladies are in the present state of society. Namely, her appetite is pretty good — fluctuating of course ; she only has a head-ache now and then, and a pain in the back occasionally ; pain in the left side we say nothing about, because all young ladies are subject to that; palpitation of the heart she is free from, except upon a little exertion ; the bowels are some- what constipated, but she appears to suffer no inconvenience from it, so what does that signify ? She menstruates every month regularly as clock-work to a day, but — suffers con- siderable pain on each occasion, &c. Such a young lady, in such health, goes to a ball, concert, or some other fashionable, and therefore crowded, place of amusement, we will say, during her monthly period. Of course she remains till a late hour. She then, when her skin is at the hottest, and her excitement at the highest, steps out from an atmosphere of 80° F. into the cold, night air of 30° F., each, of course, more or less. Her body is shielded by the most flimsy attire, and THE SAME PERSON ATTACKED BY DISEASE. 185 probably with no additional covering whatever, or merely a gauzy shawl thrown across her naked shoulders. She shivers as she springs into her carriage, and remains chilly till she reaches home. The next morning she is astonished to find she has taken cold. But there can be no doubt about the fact, for menstruation has ceased. But what is the immediate cause of this arrest of function ? Let us sift it thoroughly ; it will repay us with interest for the trouble. When the young lady was in the heated atmos- phere of the assembly-room, there was a genial glow over the whole surface of the body, and the skin was perspiring freely. No sooner does she encounter the chilly air of night, than this copious discharge is checked. And the tide of blood, that was flowing into the skin to maintain this secretion, is bent from its course, and has to direct its current elsewhere. The organ, that in the case before us invites its approach, is the womb. But this organ is al- ready congested in the natural fulfilment of its function of menstruation. When therefore it receives into its tis- sue an additional quantity of blood, it becomes more than congested. It inflames! Its lining membrane becomes dry, hot, painful, and tumid. The menstrual secretion, that was till then in action, is interrupted, and speedily stopped entirely. Now the arrest of any healthy function is disease. And the poor girl is now at all events, if she were not before, actually, unmistakeably diseased. And lucky is she if the distemper stop here. But frequently, alas ! how frequently does it happen, that this is but the starting point of a course of miseries, that shall endure, till kind death removes her from their grasp. The engorge- ment of the womb is often followed by the appearance of a papular eruption, especially about the neck of the organ. And these pimples after a certain period ulcerate, produc- ing open superficial sores. Now arise painful symptoms no longer of a temporary kind. Mucous, purulent, or bloody discharge flows from the ulcer. Neuralgic pain ?)i 2 b 186 GEEAT VALUE OF THE SITZ-BATH the back, abdomen, hips, and thighs harasses the patient. To this is added a sense of fulness, and bearing-down weight in the region of the uterus. Sympathetic feverish- ness deprives her of appetite, gives her occasional head- ache, heats and dries her skin, renders her nights wearisome and restless, and vitiates and obstructs all her secretions. After this she is probably confined to the recumbent posi- tion, and is in effect debarred half the pleasures of exist- ence. In this miserable state the hapless lady may con- tinue for many years. The complaint does not kill her. It were better perhaps if it did, for the blessings of life are sapped. These latter remarks apply to the time before hydropa- thy was introduced, for the author believes, that the condi- tion described above is totally incurable by medicinal means, and he knows it is very frequently curable by hydropathic. He has at this moment a lady in his house, who has suffered for six or seven years precisely in this manner — who has endured the most prolonged, and agonizing pains — who has undergone all sorts of medicinal treatment, with results generally detrimental, sometimes indifferent, never successful — who has been at other hydropathic establish- ments, always with some, however little benefit — and who is now, after having been a confirmed invalid for so many years, so remarkably improved, that there is no reason to doubt but that she will be perfectly restored. Perfectly restored! And that too after all the joys of existence had been turned into sorrows, and life had become an unwel- come partner. But let us suppose that the affection under discussion has not arrived at this extreme point. The womb is engorged with blood, but there is no ulceration. Still there has pro- bably been produced so much derangement of the uterus, as to unfit it for the discharge of its function of menstruation for the following one or more periods. And as the system would suffer, unless there were some supplementary action . SUPPRESSED MENSTRUATION AND LEUCORRH(EA. 187 instituted, nature calls upon another texture to undertake the office, which the uterus is r^o longer capable of per- forming. And in this way is established a leucorrhcea. But the part, whence this discharge issues, is not able to eliminate a red secretion, like the true menstrual fluid, but it can produce a white one, possessing very analagous qualities. This therefore is achieved, and now, instead of the normal periodic red menstruation, there is substituted an abnormal, persistent, but irregular, white menstruation. And when this state of tilings has once existed, all the medical faculty know how difficult it is to be radically cured. For, although after a certain time the uterus may recover itself, and become once more fit to accomplish its natural office, yet the parts upon which has devolved in the interim the uterine duty, manifested by the leucorrhcea, have become so accustomed to their unnatural state, that there is extreme difficulty in correcting it, and restoring to the uterus its legitimate secretion. Now it is here, in cases like these, where the judicious employment of the sitz-bath is invaluable. If the patient take a cold one of short duration, the water causes to contract all the blood- vessels that come within its influence. By this contraction are their contents in a certain measure squeezed from their interior. In other words the blood is driven from the parts immersed. And by a permanently astringing or tonic effect, exerted by the water upon the contracted coats of the vessels, it is also maintained at a distance. But the leucorrhceal discharge is formed both from and of the blood. Wherefore the greater the expulsion of blood from the parts, the more is the white secretion checked ; which is the object desired. It follows from these premi- ses, that the cold sitz should be employed only during the intervals between the periodic attempts at regular menstru- ation. Such periods are generally marked by some such symptoms, as pain in the back, or hips, or abdomen, bear- ing-down pains, headache, &c. During the prevalence of 188 THE SITZ-BATH IN VICARIOUS MENSTRUATION. these symptoms the cold sitz must give place to the hot one. In which case instead of an expulsion of blood from the parts immersed the contrary effect will be produced, namely, a derivative one; that is, the blood is drawn from all quarters towards the parts immersed. This therefore, aided by the natural efforts of the womb itself, is the very thing calculated to restore to that organ its proper func- tion. Hence it appears, that a judicious interchange of the cold and hot sitz-bath in this land of disturbance of the uterine system, is likely to be followed by the most benefi- cial results, suppressing the leucorrhoeal discharge, or white and spurious menstruation, as it may be called, and re- instating the red, natural, and real one. Let the reader carefully bear in mind however the different circumstances to which particular attention must be paid. Firstly, the cold bath must be of short duration, and frequently re- peated. Secondly, it must be discontinued, and the hot one substituted, as soon as the proper menstrual period is at hand, to be again repeated after that period has passed away. Thirdly, the hot bath must be hot, not tepid, and it should remain hot all the time the patient is immersed therein. Without strict attention to these points a failure will be the inevitable result. In vicarious menstruation, that is, where in the place of the normal uterine discharge there is substituted a periodic escape of blood from some other part, as the nose, stomach, lungs, rectum, &c, this alternation of the hot and cold sitz is equally useful. In these cases the cold bath acts as a tonic to the uterus, imparting to that organ such strength as shall enable it to perform its functions when the proper period shall arrive, while the hot one is a derivative, draw- ing blood towards it, out of which it may elaborate the menstrual secretion, when the correct period has arrived. It will perhaps not be an unapt method of concluding this treatise by drawing up a brief general GENERAL REVIEW OF THE PRECEDING FACTS. 189 SUMMARY. The wet-sheet lowers the pulse, diminishes the heat of surface, and relieves pain. It is therefore in medical lan- guage an antiphlogistic or febrifuge, and an anodyne. It corresponds to the lancet or leech, antimony, calomel, and opium,and other febrifuge and anodyne mixtures. It differs from the four first-named in not being followed by general debility, cachexia, &c. The douche sometimes elevates the pulse, but always ac- celerates the function of respiration, thereby imparting an enlivening influence to all the vital phenomena. It is therefore a diffusible stimulant. Its physiological effects may be compared to those of ammonia, or those produced by the exhibition of small, that is, stimulating doses of opium. Of course its beneficial action is much more per- manent than that of either medicine, and it is not liable to be followed by the deleterious consequences that the latter, even in the minutest quantity, does sometimes engender. The blanket-packing quickens the pulse and produces perspiration. It is therefore a stimulant and sudorific. But both in its mode of stimulation, and in its sudorific properties it is peculiar, and stands alone. There is nothing in the pharmacopseia, to which it can be compared. The profession would do well to adopt this process into their therapeutic catalogue. In certain chronic diseases of the chylopoietic viscera, more especially of the liver, when it is not contra-indicated by any active irritation, they would find it a valuable addition to their remedial agents. The shallow-bath generally quickens both circulation and respiration, always the latter. Like the douche therefore, it is a diffusible stimulant, but of less power. The sitz-bath lowers the pulse, but leaves the respiration unimpeded. Moreover, with some exceptions it reddens the skin of the parts immersed, of course provided the process endure long enough. It is therefore a sedative, a 190 COLD WATER AERATES AND PURIFIES THE BLOOD. purifier of the blood, and a derivative or counter-irritant. In the first of these properties it perhaps more nearly re- sembles foxglove than any other drug. In its third effect, that of counter-irritation, it may be compared with blisters of different kinds and liniments. But with regard to its power of purifying the blood, of course no medicine can compete with it. All the purely hydropathic appliances agree in one im- portant peculiarity. The wet-sheet, the douche, the sitz, the shallow-bath, the other simple baths, as the can-douche and dripping sheet, nay, even the blanket-packing, all dis- turb the previous balance or equilibrium of the heart and lungs in favour of the latter. That is to say, the respira- tion is augmented beyond the proportional speed of the pulse. If the pulse be diminished in rapidity, the respira- tory process remains unaffected. If the pulse be station- ary, the respiratory movements are increased. If the pulse be accelerated, the respiration is still more accelerated. In the same ratio that this function is expedited, are the aeration and purification of the blood more complete ; and, as this fluid of fluids becomes chastened in quality, so do all the complex processes of the economy become more per- fect in their action ; and as these functions recover their normal activity, old-standing and deep-rooted disease melts away, and long-absent health regains her ascendancy. WILLIAM IRWIN, PRINTER, OLDHAM-STREET, MANCHESTER, LIBRARY OF CONGRESS *Sit* -