IN the pathological and symptomatic make-up of sick humanity, fever and inflammation cut such an important figure as to be practically present everywhere in all the forms of disorder that afflict the rage. These so uniformly go hand in hand that we rarely witness one without the other in any given case of disease. No well-marked case of established fever will long prevail without sings of a local inflammation.
In exceptional cases, where the local inflammatory manifestation is very circumscribed and involves only a limited amount of anatomical structure, the febrile manifestation may be so slight as to form apparent exception to the rule, that fever and inflammation are practically constant in symptomatic and pathological association.
The celebrated French physician and scientist, Broussais, spent much time and literary effort to establish his theory that every case of fever is attended by its local phlegmasia. With equal propriety might he have spent time and effort to establish the proposition that every local phlegmasia has its associate febrile condition. Of the two conditions, interest is concentrated in the phlogistic or inflammatory state, both in a pathological and therapeutic point of view. In a pneumonia we have an eye to the lung involvement as a mode of relief for the pulmonary fever; in rheumatism, to get rid of the fever by a relief to the articular surfaces; and so on in gastritis, enteritis, cerebritis, carditis, cystitis, etc.
Practically, the successful management of inflammation constitutes the summum bonum of professional effort.
From the times of Hippocrates and Galen down to the early years of the present century, the best lights in the profession taxed ingenuity and thought to arrive at a correct theory as to the nature and cause of inflammation, partly as matter of scientific interest and practically to institute modes of treatment. These various theories, with the names of the authors annexed, have been stated, re-stated, discussed, and re-discussed so often and so amply that a rehash here would seem tedious and unnecessary. The leading ones have been the vitalists, humoralists, super-excitationalists, mechanical and chemical.
We think it safe to affirm that in every well-marked inflammation there are qualities and conditions involving the main element in each of these theories. It is a wise provision of nature, in the direction of human experience and activity, that as we grow gracefully old we become more simple, modest, and less pretentious; so that, as a profession and as individuals, we have come to esteem and define inflammation as an association of appearances known as heat, pain, swelling, tenderness, and redness. Of course, this association of conditions becomes in the future of matters fruitful in such superadded conditions as suppuration, ulceration, gangrene, atrophy, hypertrophy, and the various dyscrasias.
Having disposed of the various theories above so summarily as of little value scientifically or practically, we are in some sort stopped from much privilege or latitude in this line ourselves. But we think it entirely safe to affirm, as a conclusion drawn from observation and experience, that every case of inflammation consists essentially and primarily in a capillary blood stasis of the part. Physiologist teach us that that innumerable mesh-work known as the capillaries stands as the half-way place between the veins and arteries. Whether the motion in these little radicals is a vis a tergo from the heart, or by capillary attraction, or by a sort of successive vermicular contraction, is still matter sub judice.
We know, however, that upon the successful transition of the blood through these little tubules depends the suitable performance of that covert, mysterious performance known as assimilation and disassimilation- the repair after waste and wear and the removal of physiological debris. Now, any hurt or adverse agency, whether traumatic or toxic, which interferes with the capillary motion is at once announced by inflammatory manifestations-heat, pain, tenderness, swelling, and redness.
I believe the theory or idea has been generally conceded that the excess of blood in a part under inflammation depends an invitation of the circulation to take direction to the particular locality of the part under affection. I confuse I have never been able to see either fact or sense in such explanation. Of course, there is an excess of blood in the part. How does it occur? I should say it depends upon a failure of the capillaries to send it along. They have received a hurt, either traumatic or toxic, and fail of the part of their function. At first it may be slight; stasis adds to the obstruction; until, after a short while, obstruction and capillary failure become so complete as to arrest all motion, to be followed by extravasation, death of tissue, suppuration, ulceration, gangrene.
Common-sense would seem to say or indicate that whatever helps the disabled capillaries in an effort to send the blood along must be palliative,curative, helpful. Leeches, blisters, cupping, blood-letting have heretofore been supposed to be the means to this desirable end.
As the result of observation and experience, I have pleasure in stating that moist heat has a range of power and opportunity for such a purpose unequalled by any therapeutic agent in the whole resource of the curative art, whether we consider it in reference to power of action or wide range of applicability. It is an easy matter for the busy, enthusiastic practitioner to get himself under the banners of a fad or a hobby-things which I formerly held in much odium and dislike.
Lately I have fallen into much favor with such modes of thought and action. A good hobby or a good fad, if pushed with reasonable discretion, will certainly enable in the premises. Any excess or mistake may be safely left to the corrective help of experience and conservative observation. In a presentation of the claims of moist heat as a therapeutic agent I can hardly expect to present anything specially new. I simply desire, in a systematic way to gather together the various details and modes of its uses and activities.
I opine some of my auditors will feel surprise at the conclusion of my contention, at the great range of activity of this simple, everyday agent. Precisely how it quickens capillary action and sends the blood along the normal modes and channels, I do not pretend to explain. That it brings relief in curable cases and palliation in others not curable, is beyond contention or controversy.
In the management of nervous disorders, insomnia, rheumatism and cutaneous affection, the vapor bath is of the very first importance. Submerging the entire body i hot water is in the same line and of very great value. In the early part of the present century an ignorant, illiterate new York well nigh revolutionized the then prevalent modes of treating disease by the introduction of what soon came to be known as the “Thompsonian Practice,” Thompson being the author of the plan.
He came upon the stage of professional action at a time when poor sick humanity was in agony and despair from the heroical uses of the lancet, the scarificator, the blister, plaster, salivation, purging and vomiting. Taking advantage of the odium attaching to these modes, Thompson and his coadjutors had for a time a wonderful run of success. His treatment consisted almost exclusively in the use of the vapor bath coupled with the abundant ingestion of hot plizans; so that the patient had moist heat galore internally and externally. He made abundant cures, but the system gradually fell into disuse from certain crudities and excesses attending its administration.
The great success of the celebrated hot springs in various parts of the world, of which “Hot Springs” Arkansas is a reliable example, is simply attributable to free bathing in hot water and the free drinking of the same on an empty stomach. Precisely the same results might be attained in the private family home if method and persistency could be accomplished in the use of the hot water internally and externally, with exemption from worry and business cares. The “Turkish Bath,” now so popular as a luxury as well as in the cure of disease, has its chief resource in the moisture and heat, together with certain manipulations incident to the administration.
The hot “size-bath,” so useful in various pelvic disorders, has a marked influence upon the condition of the patient generally, while acting well upon parts locally. Much the same may be said of a hot “foot bath,” I doubt if the same amount of hot water could be applied to the same amount of external bodily space elsewhere with the same good result. In a violent acute brain disorders a protracted hot head douche will sometimes act like magic. In the thirst, nausea and vomiting attending many cases of strong fever, nothing so quickly allays the symptoms as constant sips of hot water repeated for ten or fifteen minutes. Hot irrigations of the intestines, with hot abdominal fomentations, bring great relief in acute dysentery.
In cerebral and cerebro-spinal meningitis hot-water bags to the head and spine will be found far better practice than the habit of freezing the patient to death with ice-packs and ice-bags. Chronic dyspeptics who suffer from eructations, furred tongue, bad breath, bad taste in the mouth, constipation of the bowels, scanty urine, may be greatly benefited by drinking a large goblet or two of hot water on an empty stomach at early rising and at bedtime. The water may be acidulated with fresh lemon juice. In very obstinate cases of this kind much may be gained by systematic hot fomentations over the epigastrium for two hours at, say, from 7 to 9 P.M., the applications being renewed every twenty minutes.
A good hearty sip of hot water should be taken with each renewal of the compress. This plan of hot-water drinking on a n empty stomach with the evening fomentations should be continued every evening from two to four weeks, according to the needs and obstinacy of the case. I remember very distinctly getting this plan and idea some thirty years or more ago from a book on Water Cure, by an English author, Dr. Gully who enjoyed much celebrity and practice at the time. It is very remarkable how much hot water may be taken on an empty stomach, with little or no inconvenience to the individual.
In cool or cold weather it pours away through the kidneys and bladder; in hot weather it finds additional outlet through the skin in the form of perspiration, bringing a peculiar sense of cleanliness and bodily renovation, with improved secretions and excretions everywhere. I have come to attach importance to the lemon acid addition to the water, as rendering the water more palatable, and, besides, exerting a good influence on the stomach and other organs which it may reach. I usually prescribe the juice from half a fresh lemon to a point of water. Should so much juice put the “teeth on edge,” the quantity must be reduced or taken less frequently.
The whole range of poultices and poulticing, whether in domestic or professional practice, would seem to depend for efficacy upon the heat and moisture contained. Every old mother or nurse knows full well that the poultice cases to do good when it gets cold. In mastitis, peritonitis, pneumonitis, pleuritis, and the whole family of furuncles, the good to be derived from the time-honored “mushpoultice” is attributable to the heat and moisture in the application. A flannel out of hot water might do just as well, except that it loses its heat and moisture too soon, necessitating the trouble of too frequent reapplication.
I remember very distinctly a case of infantile pneumonia which I had visited and prescribed for daily for a period of ten days or more without success. When I came to make my morning call I was agreeably surprised to find the child bright and almost well, fro being quite ill at my last visit. The mother told me in a sort of beg-pardon, apologist manner, that she had applied a poultice to the patient’s chest the night before. By the way, the best material of all others, for a poultice, is flax-seed meal. It retains heat and moisture well, and has oil enough to prevent adhesion to the skin surface.
We come not to speak of a most valuable use of moist heat in the management of the various uterine disorders. The use of this agent in the domain of gynaecology does not seems to have received any special, systematic attention until within the last ten or fifteen years. Now, it is the fad of the hour, and, like many other good things in the hands of indiscreet zealots, has received some misuse in the house of its friends. Many a poor woman is to-day being soused, drenched and irrigated, beyond all reason and propriety, at the hands of those without wisdom or discretion. The abuse to which a misdirected zeal has brought it, is only an argument or fact that there is much in it for good as well as misuse.
To-day, if I should be offered the alternative to give up very other known form of local application, or accept hot water, as my only resource in such cases. I should unhesitatingly adopt the hot-water treatment as against everything else n the local line. Not that I underrate other agencies and modes, but this much by way of indicating the importance I attach to the agent I am now commending. I have now arrived at the point in my daily professional experience where I may say that I begin the treatment of every case of sexual disorder in the female with hot water irrigations. These are prescribed for morning and evening observances, from one-half gallon to one gallon being used at each application, from a fountain syringe. In every obstinate cases I add the use of the hot sitz-bath for ten minutes every twenty-four hours.
If there be constipation of the bowels the colon should be filled with hot water, once in the twenty-four hours, to be retained as long as possible, jointly for help to both constipation as well as the uterine disorder. The colon full of hot water for the time acts much as a poultice might in behalf of the sick uterus and its appendages. In the adoption of this mode I do not stop at nice distinctions as to whether the case be one of cervicitis, endometritis, perimetritis, ovaritis, uterine displacement, or sub-involution. In most cases of long standing, several, or al of these conditions, exist. Each and all are benefited by the treatment. Usually this mode of treatment embraces and exhausts its opportunities in from two to four weeks.
Protraction beyond this probable limit will not only be useless but may prove a source of defeat or even draw-back. Any powerful agent in the treatment of disease has its limit as to usefulness, beyond which an adverse result may be expected. I beg you to indulge a slight digression while I say in most cases I conjoin the glycerole cotton tampon with the hot water, and with great seeming advantage. Indeed, I sometimes find myself almost at the conclusion that these two agencies are well nigh equal to the relief of any and every form of sexual disorder peculiar to the female. In this sweeping declaration, of course I provide exception for the demands of surgery in case lacerations, abnormal growths and malignant troubles.
As a haemostatic, hot water has come to be a valuable resource n violent haemorrhages, especially when from one of the bodily cavities, as the stomach, the bladder, the uterus, or the intestines. In such cases it should be used just as hot as will not endanger tissue integrity, and in bold, large quantities, thrown in forcefully with a syringe in a continues stream, until some effect shall seem to have been reached. It is noteworthy that in cases where the hot water may seem a failure, the other extreme of cold water will almost surely succeed. The alternation of hot and cold water will almost surely succeed. The alternation of hot and cold water in bad uterine haemorrhages is sometimes of the very first moment.
As a disinfectant and general renovator about the sick room, it would be hard to overestimate the value of steam and hot water. They have absolutely all the elements of success- cheapness, efficiency, promptness, harmlessness. We are decidedly of the opinion that entirely too much attention has been given to loudly vaunted proprietary compounds, as disinfectants, to the neglect of the two valuable agents we commend.
We believe all parties are now quite agreed that no germ, real or supposed, and no toxic effluvium emanating from the sick body, can maintain identity and integrity under the action of water at 212 degree or steam at a higher degree. All toxic or germ activity is not only killed, but killed, neutralized, and washed away. There is no way so effective for renovating a sick chamber and all its belongings or contents as by the free use of steam and boiling water. An advantage under the steam and water regime is, that tapestries, clothing, etc., are not the worse, but rather the better, generally for future use if desired.