This article is taken from book by PROF. DR CURRAN POPE, published in USA. We would like to present it to the bigger group of readers, especially when it is very difficult to be found anywhere. Therefore we took this opportunity to present this interesting matter

Association

-------------------------------------------------------------------------------

Write Us!

 

 

TECHNIQUES OF HYDROTHERAPY- DOUCHES

PRACTICAL HYDROTHERAPY

BY

PROF. DR CURRAN POPE

In nearly all of the preceding methods of treatment that we have considered the human hand has taken an active part in the application, but in the douche the physiological effects are obtained by the use of apparatus which drive or throw the water upon the entire or various portions of the skin surface. The many forms of application of hydrotherapy reach their acme in the douche, and this instrument of therapy is the aim and object of most operators, for by its use the most powerful physiological effects may be produced. The douche is the most satisfactory, flexible and adaptable tonic in hydrotherapy, and is capable of producing changes marvelous to those who are unacquainted with its use and effects. It should be noted that in douches we have to deal not alone with thermic impressions upon the surface, but with mechanical effects as well, which are of a perturbating or concussive character, and while this latter plays an important part in the effects of the douche, yet the temperature effect is in reality the most important. It is to be noted in all methods by which water is driven against the human body that its action is strictly limited to the moment of its application, as the water at once flows or falls from the surface. A douches, therefore, is the application of water to the body surface in single or multiple columns or streams at different temperatures and under varying degrees of mechanical stimulation, the latter derived from atmospheric pressure. There are different kinds of douches. They may be administered from a nozzle with an opening so fine as to make the application painful, or broad like a fan, or as multiple little streams. Each and every douche may be hot, cold, or may be alternate hot and cold; in the last named the sudden thermic changes enhancing the physiological action of each temperature. In like manner the mechanical stimulation may be of any grade of strength from the mildest to the most powerful. It should, however, be borne in mind that the physiological action of an affusion, the mildest douche, and the jet, the most powerful, is one and the same, the difference in effect lying more particularly in the variations of the method and in the pressure used. Douches are, as a rule, more agreeable to the majority of individuals than the other forms of hydriatic procedure, because by its stimulating mechanical action it, in a brief period, not alone produces its effect, but hastens and increases reaction. For this reason institutions, sanatoria and hospitals, especially where the chronic invalid is treated, the douche is much employed, not alone for its well-known therapeutic power, but because of its brevity of application, which makes it popular with the patient and saves much valuable time where many are to be served. I am of the opinion that in the douche we have the most powerful and far-reaching of the therapeutic weapons, and one that should be more frequently used. Those who have never used (personally) a powerful douche have missed a pleasant experience, and were physicians to try this measure more frequently upon their own persons I am confident they would have less recourse to medicines in chronic diseases and make more use of hydrotherapy. It sets the tissues in a vibration impossible to describe; experienced, it is never forgotten. The writer, after eighteen years’ practical experience in a large practice, and in the daily use of hydrotherapy, is at a loss to differentiate physiological distinctions, niceties, and need for separate consideration of “liver, spleen, epigastric, perineal, ascending and descending, etc., douches,” so much insisted upon by French and German writers and by some hydriatists in this country. Owing to anatomical differences in structure and its varying vascular distribution, certain reflexes may arise that are different in one place from those in another, but the difference is so small that it can be overlooked in view of the simplicity and clearness that is gained by reducing the subject of douches to its simplest terms.

Following the plan heretofore insisted upon, the writer will give a brief description of each “douche method,” its peculiarities and advantages, and will then give the physiological action, therapeutics, etc., of douches in general. I will consider douches under four headings, proceeding from the simpler to the complex and more powerful. Douches are divided as follows:

Affusions
Shower or vertical rain bath
Circular rain, horizontal rain, needle or spray bath
Jet douche (jet or fan)

Douches are administered by means of certain attachments that are in connection or conjunction with what is known as the “douche apparatus.” In constructing the douche apparatus we should have delivered to it, in pipes not less than one and one-half inches- the author uses two- hot, cold and ice water, under a sufficient pressure to secure satisfactory results. It should be in direct connection with both hot and cold water supply, and so arranged that the use of hot and cold water elsewhere will not interfere with its operation.

Affusion: The “affusion” is a procedure by which a stream of water issuing from a bucket or pitcher is thrown or falls upon the patient sitting or standing in an empty tub. The writer uses the affusion with comparative rarity, and, as a rule, only in connection with the half bath or for some local effect. It has been his experience that it is best to employ a bucket provided with a partial covering and large opening through which a broad stream of water may be concentrated more or less upon the patient. It will be seen at once that the affusion can be made stronger or weaker according to the temperature of the water and the height from which it falls. It is my custom to generally administer the affusion from 55 to 70 F., and I have found that it is advantageous for the patient to be sitting and to administer it to both the chest and back. This, in connection with the half bath with friction, has been a favorite methods of the writer’s in treating locomotor ataxia, and to which the reader is referred in the section upon therapeutics. It has been suggested by Baruch that in conditions of coma, delirium and adynamia the patient should sit or recline in water at a temperature of 100 F., and receive the affusion at temperatures varying from 45 to 60.

It is always a good plan before administering the affusion to have the patient’s face and neck thoroughly cooled. There is just a little knack in giving the affusion, and that is to swing the bucket to a sufficient height so as to cause the water to dash against the patient; in feeble patients, where the affusion is applied to the chest, it is well to have the patient break the first part of the stream by placing his hands against the chest wall and then quickly removing them.

Shower bath: The shower bath, vertical rain, or rain douche, as it is variously styled, consists of a perforated disk from which a large number of fine streams of water fall upon the patient. This application resembles somewhat the effect of the circular rain or needle douche, owing to the large quantity of water that flows over the body surface. The temperature effects are practically the same as in all douches, but the mechanical or pressure effects are less than in the next two forms to be considered, although it is greater than in the affusion. The rows should be so arranged that the water can be made to fall upon the head at an angle when this is so desired, as some patients are exceedingly sensitive to water falling straight down upon their head. This is a procedure of considerable value, and is quite a stimulant to the nervous system, and possessing many of the valuable effects of the douche. This is the favorite percutient measure in private homes, and the shower or vertical rain is now a part of nearly every well-kept private bathroom. In sanatoria, as a rule, the rows permit of larger volumes of water under greater pressure than is found in private houses. The shower is a part of the standard apparatus manufactured by companies, who deal in plumbing supplies, and is easily obtainable at reasonable prices.

Circular, Horizontal, Rain, Needle or Spray Bath: In my sanatorium I employ two kinds of circular, needle or rain baths, one of which is the old-style needle bath supplied with semicircular perforated pipe and attached to one of the mixing chambers of the douche apparatus. To the left of it stands a circular needle bath, popularly termed in the institution the “triangle,” which was originated by Baruch, and which the author has had in use for a number of years. This consisted of three standard upright brass nickel-plated pipes to which are attached four or five rosettes three inches in diameter, containing approximately fifty fine openings, the three upper rosettes so arranged that the stream of water may be directed downward, so that a person of short height will not receive the volume of water upon the face and head. In the older circular rain bath the writer has obviated this difficulty by the use of three stools of different sizes made of cedar wood. The circular rain or needle bath is a very active and powerful procedure, and by its use one is enabled to obtain far-reaching effects. The multitude of fine streams under considerable pressure falling upon a large area of cutaneous surface, stimulate by their thermic and mechanic effects all the structures immediately in contact with the water and arouse extensive reflex action. It is a milder procedure than the jet douche and a stronger one than the shower bath. This bath has in the writer’s hands yielded him some of the most satisfactory results obtainable in the whole field of hydrotherapy, and it would be difficult to substitute as effective a weapon should this be lost to the profession It is especially valuable for women, many of whom do not stand well the stronger jet douche.

Jet Douche: The jet douche or “hose,” as it is called in the parlance of the bath-room, consists of a hose attached to one of the outlet pipes of the douche apparatus, and to the other end of which is a metal connection to which can be screwed various attachments for modifying the size and shape of the stream delivered to the patient. The jet douche is usually administered through a nozzle, the diameter of the opening ranging from one-fourth to one-half inch. As before stated, the douche apparatus should be so arranged as to possess two of these jets in order that the Scottish douche may be administered. The jet douche is, in the opinion of the writer, from careful clinical observation and from long personal experience, the most powerful of all forms of hydriatic treatment. Administered at high or low temperatures, under a strong pressure, it is capable of arousing the most sluggish and intolerant function of the human body. It is a powerful invigorant, revulsive and sorbefacient when administered as a Scottish douche for local conditions, especially of a chronic inflammatory nature, particularly when located in the extremities.

The fan douche is nothing more or less than a very simple modification of the jet douche, and while there is a special nozzle or attachment for producing the fan douche, the author would not advise its use, as it is really objectionable rather than beneficial. The simplest way of producing the fan douche is to place the finger over the nozzle of the jet so that the water will fall upon the patient in a broadened and thin stream. In this way certain structures that would be unable to stand the action of the jet douche gain all the value of this application without having sensitive parts subjected to the pain and discomfort that the full jet might produce. In case the temperature used are too high, and the force of the stream too strong for the human finger to stand, by the use of a small piece of wood, preferably of cedar, the stream may be broken without having the attendant suffer any discomfort from the temperature administered. It is the writer’s favorite method to combine the fan and jet douches, using the fan douche upon the chest and the tender walls of the abdomen, and the jet douche upon the spine, back, lower limbs and feet. It is for this reason that I do not advise the use of a special nozzle, as it would compel the removal and reattachment of these nozzles several times, during the interim of which the patient would become chilled, thus robbing him of all the benefits that the douche commands.

The perineal douche is a modification of the jet, and is applied through a nozzle directed from the floor, the patient being seated upon a stool through which a hole had been bored to permit the stream to reach the perineum. This douche is of some value in the treatment of sexual weakness, prostatic troubles and hemorrhoids. It should be gently applied at the start and gradually increased in force.

The Scottish or alternate douche is simply the alternate application of a hot jet douche followed by a cold jet douche. While it is generally employed as a jet douche, still it may be applied in almost any form of douche. In the application of the Scottish douche it should be borne in mind that there is, as a rule, a ratio between the application of heat and the application of cold. Roughly speaking, it is usually four or six to one- that is to say, the hot application should, as a rule, be long and the cold application short. Reducing it to time, the hot application should range somewhere between one-half and three minutes, and the cold application from five to thirty seconds. The aim and object of the Scottish douche is to intensify the revulsive effect obtained from both the application of the hot and cold water. Where we have to deal with conditions that are local and which especially affect tissues such as joints, sciatic nerve, etc., an excellent method of treatment is to precede the use of the Scottish douche by a general sweating method. Its application combines all the physiological influences of both the hot and cold douches, and, in fact, rather intensifies their action. It is one of the most powerful absorbents of inflammatory material that can be placed in the hands of the therapeutist. It produces, in addition, a marked mechanical influence. The temperature usually administered range from 100 to 125 F., while the temperatures of the cold water range between 55 and 70 F.

It may be stated that a sine qua non to its successful use is ability to manage and direct the forcible impact of water upon the whole body or any part of it; the operator should be able to control the form, temperature, pressure and duration of the douche. It should be noticed that variations in temperature and pressure are easily distinguished by patients.

Practical common sense will at once see that while there is a difference in the effect of water acting in a concentrated form, as in a jet douche or in the separated multiple little streams of a circular needle douche, yet this is only a difference in degree and extent rather than an ultimate physiologic difference. Douches are usually administered at temperatures ranging from 45 to 120 F., and where they are very hot or very cold they should be of brief duration and act as stimulant, increasing tone and well-being. Hot douches (104 to 110 F) should not exceed, in general applications, a half to two minutes, preferably as an average one minute, the hotter the douche the briefer the time. Cold douches (45 to 70 F) should not exceed, in general applications, ten to thirty seconds, preferably as an average fifteen seconds, and likewise should be proportionately briefer the lower the temperature. It is an excellent rule to commence treatment with a temperature of 100 F for one minute, followed by a reduction to, say 80 F., for ten seconds, increasing the hot water one degree daily until 104 F is reached, and reducing the cold water two or three degrees daily until 60 or 50 F is reached, and in like manner increasing pressure steadily.

Cold temperatures are secured in summer by ice water obtained by passing water through a coil of pipes surrounded by ice. This is only necessary in summer. In some places water of sufficiently low temperature is obtained by sinking deep wells, thus obviating the trouble and expense of the ice-box.

The jet is usually administered with the patient standing, but if he be quite feeble he may sit. In many cases it is well to combine the different forms of the douche in an application, beginning perhaps with the warm circular needle douche, finishing with the cold fan douche over the body and the cold jet to the spine, legs and feet. Where the entire body is treated we would expect general physiological effects, and where the applications are local purely local and reflex effects. The most pronounced local effects are found in the Scottish douche The douche should never be administered except upon the order or under the medical direction of a well-trained hydriatist, as it is too vigorous an application for the uninitiated or to be left to careless routine treatment. The jet douche is usually applied to the back first, then the legs and arms, and then slowly broken for the chest and abdomen, and lastly to the feet. Where general effects are desired, and some local effect in an organ is sought, the cold feet should be applied as a finishing application over the part it is desired to most influence. The action of the douche, as in many other measures, is enhanced by some procedure that has for its object the increasing of the cutaneous circulation, the collection of heat upon the surface and the increasing of skin sensitiveness. To this end the wet and dry pack, superheated dry hot air, the hot-air box, steam box, the incandescent electric light, the arc light, etc., are used. After no inconsiderable experience, I feel that the general requirements are more nearly met by the incandescent electric light bath than any other known method, and I give this preference except in special cases. The aim and object of the douche is to bring the patient, as soon as possible, under the influence of low temperatures and high pressure. The favorite method of use, however, is first to give a hot or warm douche, following same by a cold one of brief duration. The douche should always be kept moving, and by so doing many disagreeable sensations of heat or cold will be obviated.

Reaction is more immediate and complete, for the colder water and briefer application, coupled with the mechanical stimulus of the impact, overcomes the depressing effect of the low temperatures; in fact, the skin frequently reddens under the cold water during its application in those whose reaction is well developed. Owing to the limited areas over which various douches play, and the accompanying massage, they do not produce the painful impressions as if the patient was totally immersed in cold water. The author believes that the best results are obtained from brief douches under considerable pressure and thermic change adapted to the individual case. The douche encourages both thermic and circulatory reaction- the former brought about by rapid cooling of the skin surface, the latter because of the intermittent mechanical vibrations of the stream upon the surface. It will thus be seen that all douches depend for their effects upon six factors, viz.:

Form- affusion, circular needle, jet
Temperature- hot, cold, alternate hot and cold
Duration- short or long
Pressure- amount of mechanical stimulation
Distance- from attendant
Local and general applications

Physiological Action of the Hot Douche: This has been incidentally considered in the foregoing remarks, but we will now take up and consider in detail the physiological action of the hot douche. The temperatures range from 100 to 125 F., though the latter or higher temperatures are only borne after hydriatic education. Local applications may be made at much higher temperatures than general ones, higher with moving than with still water.

The influence upon temperature is to first produce a reddening of the skin owing to the close relation between temperature and vascularity The temperature of the body is raised if the application is general or a local rise if localized, this increase being due to the prevention of heat elimination and by increasing its production.

Its influence upon circulation is active. The first and transient influence is to contract the peripheral blood vessels, followed almost immediately by dilatation, atonic in character and causing a passive congestion of the skin, which becomes of a cherry-red color. The heart is first slowed, with temporary increased force of pulse beat, but soon it becomes accelerated, due to dilatation of the arterial system in the skin, coincident with perspiration and a lowering of arterial tension. As a reflex effect the internal blood vessels are contracted. The cerebral blood vessels may dilate at the start and give a sensation of oppression in the head, of tightness and throbbing. Later the dilated peripheral blood vessels cause a reflex contraction of the cerebrals ones, causing an internal anemia, especially of the brain, demanding in both instances cold applications to the head.

Upon respiration the influence is to increase their number, diminish their depth and to produce a slight feeling of weight and oppression upon the chest. Moist heat produces these effects at a much lower temperature than dry heat, and in the latter inhalation of the hot air increases the effects. There is a greater heat loss by exhalation and respiratory activity.

Upon metabolism, the most intricate process of vital action, the effect is to increase the action, directly stimulating perspiration, the glandular action of the skin, and increasing the elimination of waste material by increasing the secretion, elimination and oxidative processes of the body.

Upon the nervous system heat is a powerful excitant, and where long continued may lead to exhaustion. Applied to the nerve terminations in the skin, its influence is conveyed to the spinal cord and thence to the heat centers in the medulla, stimulating vital processes. These sensory impressions are of a powerful character, and give rise to myriad reflex effects. After a short time stimulating effects give way to relaxing, sedative and depressing influences, well known to those who use the hot bath. Headache, sense of fullness or band-like feelings about and around the head, giddiness, lightness and cerebral oppression are some of its later effects. Upon the peripheral nerves it is, under low pressure, analgesic, under high pressure stimulant. Muscular nerves are markedly influenced, spasm being overcome and relaxation taking place.

Reaction is transient and is followed by atonic conditions.

Therapeutics of the Hot Douche: Its principal value is that of a preparatory or alternate to the cold douche, and is rarely used alone. Where we have to deal with superficial tenderness, hyperesthesia, in neuralgia, etc., it sometimes proves of value alone, but the writer has found even in these cases the necessity exists for following their application with carefully graduated cold applications. The hot douche reaches its maximum value in connection with cold percutient measures, and is only valuable in this connection.

Physiological Action of the Cold Douche: The writer is firmly of the opinion that the cold douche should never by used without the preliminary and preparatory influence of heating procedures or the hot douche. Cold applications of low temperature is the aim of the hydriatist, together with maximum mechanical stimulation.

The action of the cold douche upon temperature is to primarily produce a chilling of the surface and contraction of blood vessels. The capillaries of the skin contract, the flow of blood to the skin is checked. The douche does not reduce systemic temperature, for the system rallies to overcome its effect, the development and production of heat being increased. The temperature of the surface in contact with the cold water may be lowered, but only temporarily. The percussive or mechanical effect of douches lessens the impression of cold, and lower temperatures may be advantageously administered.

Upon the circulation the cold douche is decisive and tonic in action. During its immediate application the heart’s beat is increased, the pulse is smaller, but the subsequent effect is to lessen the number of beats and to markedly increase the volume of the pulse, while at the same time the flow of blood through the heart is accelerated. There is a rise in blood pressure under its use, but a secondary diminution takes place when the peripheral blood vessels are filled by reaction. Immediately under the stream of water the skin becomes blanched, followed by a return of color as the stream moves and is allowed to fall on another part, probably due to the weight or concussion of the water driving the blood out of the tissues. When reaction takes place the blood vessels moderately dilate, retaining what is called “tone” or tonic reaction, and this in the douche is noticeable even in the smallest blood vessels. For the maintenance of the general circulation there is nothing, in my opinion, comparable to the cold douche. The quality of the blood and the number of corpuscles are greatly increased after a bath. The douche is always short in duration, thus causing it to act as a general tonic, stimulating the heart’s action as well as bodily functions.

Upon respiration the cold douche immediately causes an increased and deepened respiratory act thereby favoring the exchange of gases, with an increased absorption of oxygen and elimination of carbonic acid gas. The sudden impingement of the douche causes the chest movements to be of much greater amplitude. There is a certain amount of sensation of gasping and restriction of breathing, but this can be easily overcome by simply opening the mouth widely. With the absorption of oxygen there is an increase of the general oxidative processes of the body thus reducing the complex chemical composition of toxins to those simple elements that are easily and rapidly removed from the body.

Upon metabolism it is the most powerful of stimulants. It arouses functionation to the highest degree. The douche is eminently a destructo-constructive agent, destroying and removing waste material, first by better oxidative processes induced, and secondarily by the stimulus it gives to excretion. By the better destruction and elimination of toxic waste materials physiological processes are given an opportunity to follow the natural law of reconstruction and repair. Upon chronic metabolic and toxic conditions it is the summum bonum. Not only does it increase these processes, but all secretory and glandular organs are aroused, so that the secretion is greater in quantity and better in quality. Because of this action we find that the digestive and assimilative processes become more effective, the appetite is increase, more food taken, digested and assimilated. The lymph current is accelerated in the channels and glands, making this accessory circulation more effective in normal tissue regeneration. Flesh is gained and strength renewed. It has been demonstrated by numerous investigators that elimination is greatly increased as well as accelerated, Strasser having shown that all waste products are increasedly removed from the body by the douche. Urea, the purin bodies, nitrogen, uric acid, extractives, etc., are destroyed; the specific gravity of the urine is raised and the liver stimulated to destroy gastrointestinal poisons.

Upon the nervous system the douche exercises an influence equaled by no other procedure in the domain of therapeutics, and this statement is made with a full appreciation of its meaning. The action of the douche upon the nervous system is brought about by the mechanical and thermic impressions, which impinge in rapid succession upon the peripheral nerve terminations in the skin, energetically stimulating and arousing their action. In the action of the douche upon the various functions of temperature, circulation, metabolism, etc., the nervous system is a large factor in the production of both the immediate and reflex effects, for distant influences depend entirely upon nervous impressions and are dominated by their action. The reflex influences of neural action are enhanced by the mechanical effect of the impingement of water. The cold douche is tonic in action- a general invigorant, producing a feeling of elation and strength. Immediately after its use sensation is enhanced and the skin becomes hyperesthetic. Reflex excitability is increased, nerve centers are aroused, especially those that preside over neuro-cardiovascular structures. In its impingement upon the skin the douche gives rise to tactile and other sensations, and in this way differs from other hydriatic measures. Pressure influences the peripheral nerves according to its force, its extent and its variations; it sets in action myriads of reflexes, both afferent and efferent, producing thereby in the economy a new balance in which excesses and defects in function are corrected and physiological labor divided. That it increases nerve force and nerve regeneration is patent daily to those who use it in their practice, it being equally true that it redirects misspent and irregular nerve force into reparative and functionating channels. The most important results obtainable in hydrotherapy are secured by its use with less tax upon the neural and general strength than by any known measure. It is alterative, vitalizing, restorative. Upon the mental functions it increases their activity, acquisitive, productive and reproductive. On many occasions the author has found recourse to the douche one of the most effective and satisfactory methods of relieving mental and physical fatigue and of increasing the activity of his higher mental faculties.

Upon the muscular system Maggiora and Vinaj have demonstrated the marked increase in muscular power following the douche, together with increased capacity for work. In a large number of clinical experiments made by the author upon his own person he has confirmed these results; and, furthermore, it has a peculiar neuromuscular refreshing and invigorating effect, felt for many hours after its application. The motive power of the unstriped muscular tissue is much increased, and this is probably one of the many reasons why the stomach, intestines and other viscera are made more active. The muscular coats of blood vessels respond with selective activity to its action in connection with vascular and neural effects. By the increased muscular action heat is liberated, toxins and acid products squeezed out, followed by better tissue regeneration.

Therapeutic Application: The douche is rarely used in acute diseases, but finds its greatest field in chronic affections in which we wish to obtain a controlling influence over circulation, nutrition, and nerve tone, for in those conditions accompanied by anemia, poor circulation, malnutrition, nervous and digestive disorders, and against chronic exudates and inflammations, it is a weapon by which we may successfully attack conditions otherwise impossible to reach. In chronic diseases of the chest, in catarrhal states of the bronchi, it stimulates expectoration and facilitates absorption, this latter being especially true of the chronic exudates of pleurisy and pneumonia. In functional and inflammatory disease of the entire digestive tract results little short of marvelous are obtained by a course of douche treatment. We find that atonic, nervous and secretory disturbances are corrected, appetite and assimilation improved, flesh gained.

In many of the psychoses- melancholia, neurasthenia- of the depressed and general type, in morbidity with introspection, in hysteria, in many cases of chronic neuritis, neuralgia, sciatica and other nervous affections, there is no weapon equal to the douche in restorative power. In the chronic rheumatic, whose toxin-laden body and metabolic processes are so warped, the douche sets in vibration the entire economy, and, relieving it of its load, soon enables Nature to assert her wonderful restorative power. Where deposits have taken place in the joints, where stiffness and ankylosis without destruction have taken place, when preceded by the use of superheated dry hot air the alternating or Scottish douche is the method par excellence, and soon brings about lessened pain and increased mobility. Where the condition popularly known as “stiff back,” stiff neck, or a true myositis exists, where there is muscular soreness after an acute rheumatic attack, the douche proves an absolute panacea.

In the cases of anemia and chlorosis where iron, arsenic and other hematinics fail the douche alone will cure, but in conjunction with these useful drugs the hemoglobin and corpuscles daily increase, a fact frequently demonstrated by me from actual laboratory experience and test. Where the skin is dry and inactive or gray and greasy-like, due to improper condition of its circulation and glandular action, nothing so quickly removes the condition as the stimulating thermic and mechanical action of this form of hydrotherapy. In the sedentary and in those who are unable to take the required amount of open-air exercise, a short course of this form of hydrotherapy once or twice a year or once or twice a week will often add many moons of usefulness and activity to the individual. In the fashionable and dissipated, in those affected with “dyspeptic livers,” the douche soon rehabilitates and rejuvenates.

It can be used even in feeble cases, for, abstracting no heat and favoring speedy reaction, invigoration, not depression, is its result. In cases of inebriety and the morphine habit the douche occupies one of the highest places in modern methods of treatment, relieving the enslaving thralldom and building up vitality.

In conclusion, it must be again repeated that unless reaction is secured the aim and object of the use of these douches is defeated and the benefit to be gained thereby lost.

Contraindications: Especial care should be exercised in the use of the douche in the aged, in those suffering from respiratory troubles, and in those affected with arterial sclerosis, aneurysm and atheroma. In myelitis, locomotor ataxia, acute neuralgia, multiple neuritis, gastric ulcer, acute gastrointestinal catarrh, cystitis, acute rheumatism and eruptive diseases, the cold douche is forbidden. While forbidden in the acute phases, in the chronic cases it is useful.