This article is taken from book by prof. Simon Baruch, published in 1908 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 an interesting matter as seen back in 1914. Still some parts of this article are valid, and hydrotherapy as presented here is being used in spa treatment.

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HISTORICAL EPITOME- THE LESSON- NECESSITY FOR INSTRUCTION IN HYDROTHERAPY

PRINCIPLES AND PRACTICE OF HYDROTHERAPY

PUBLISHED 1908 BY

PROF. DR SIMON BARUCH

Prof. of Hydrotherapy in Columbia University

College of Physicians and Surgeons), New York

 

The history of hydrotherapy forms the most interesting chapter of the history of medicine; it illustrates how prejudice may thwart progress and how enlightened physiology and pathology have tended to reinstate a valuable but neglected remedy.

What remedies have survived since the days of Hippocrates and Galen? The application of diet and the use of water are really the only remedies which have withstood the test of time. Blood-letting may be cited to illustrate the fate of a remedial agent which has no rational basis. This heroic measure has for centuries been advocated and defended by the leaders of medical thought and practiced by the rank and file of the profession. Nevertheless, the last third of the nineteenth century witnessed its complete downfall from a position which no other therapeutic agent has ever occupied. As soon as the progress of physiology and pathology gave the physician a clearer insight into the vital processes in health and disease, blood-letting lost its prestige beyond recovery. Water, whose origin as a remedy is coeval with blood-letting, but which has never attained such marvelous dominance over the medical mind, enjoy today greater confidence and is more genuinely appreciated than at any previous time. Despite professional and lay prejudice, it stands today secure against successful assault, by reason of its rational basis and favorable bedside results.

A rapid glance over the history of hydrotherapy suffices to show that water is an orthodox remedy, having been first dilated upon in the works of Hippocrates, who correctly insisted that cold stimulates and warmth relaxes, and who applied it in many diseases with skill and judgement.

Among the noted men who warmly advocated water in disease may be mentioned Asclepiades, whose eminence is attested by his being the friend and physician of Cicero. He really foreshadowed “the cellular theory” by teaching that not the juices of the body but its elements and atoms are active in health, and that a disturbance of their activity constitutes the essence of disease.” He cast aside all spoliative medication and depended chiefly on diet, exercise, and baths. Celsus, Themison, Coelius Aurelianus, and Antonius Musa were his disciples, all men who occupied high places in the history of medicine. Celsus was the physician of Ovid and Fabius Maximus. Musa restored the Emperor Augustus and the poet Horace to health by cold baths (Suetonius). The philosopher Seneca became an enthusiastic “psychrolutus,” after he was cured by cold water prescribed by Charmis.

The greatest physician of the seventh and eight centuries, Paulus Aegineta, was an active hydrotherapist; he applied cold affusions in sunstroke and anuria.

In the twelfth century, Van der Heyden collated three hundred and sixty cases of malignant dysentery cured by water. Van Helmont regarded baths and affusions as superior to medicine.

In 1697, great propaganda for hydrotherapy was made by Floyer, a learned English physician, whose book was translated into German, and converted Prof. Friedrich Hoffmann. Being regarded as the most able physician in Germany, the latter diffused the knowledge thus obtained and elaborated by him over all parts of Europe.

The body physician of Frederick the Great, Theden, treated small pox, malignant fevers, and rheumatism with water.

In 1743, Hahn taught its value in smallpox and other exanthemata. That justly great physician, Hufland, was so warm an advocate of hydrotherapy that he offered a prize for the best treatise on the action of cold water in fever, the prize being obtained by Professor Froehlich, physicians to the Austrian emperor.

Despite the advocacy of these and other eminent men, water did not attain popularity until Priessnitz came upon the scene. This remarkable empiric was so successful that he treated in 1840 nearly sixteen hundred patients from all parts of the world. Many physicians from foreign lands visited this peasant water doctor, and became missionaries of hydrotherapy.

In Germany, his followers were mostly laymen. Nevertheless, the impress of his life and work can be noticed today.

Germany has been a fruitful field of research and practical demonstration in hydrotherapy, in recent times as well as in the past.

The founder of homeopathy (Hahnemann) appears to have possessed correct views on hydrotherapy. He wrote: “If there be a universally useful remedy, water must be one.” After describing his method of treating old ulcers of the leg by cold foot and general baths, he dilated judiciously upon inexactness of application as follows: “The degree of temperature of each bath and the movement in it must be adapted to the improvement in strength; the weakest body may thus reach the strongest bath, if the exact prescription of the doctor be followed with punctual obedience.” “I have never ceased to wonder how our greatest physicians could be so negligent in their prescription of the cold bath. They order half baths or full baths morning and evening, and this is their idea of a prescription. Of the degree of cold, the exact duration of the bath, and other indispensable points not a word. Surprise at the frequently reported ill effects of such cold baths must cease when these multilated, inexact, three-syllabled prescriptions produce results quite opposite to those aimed at.” This sound criticism may be justly applied to the present generation of physicians, who would add vastly to their efficiency by heeding the advice of the eccentric but evidently observant man.

To Prof. Wilheim Winternitz, who graces the chair of hydrotherapy in Vienna, medical science owes nearly all it has learned about the scientific uses of water in disease. He dedicated himself to the development of hydrotherapy in his graduation thesis, which concluded with the hope that the “knowledge of the uses of water in disease would become the common property of medical men.” Before his time there existed no physiological basis for hydrotherapy. He infused the true scientific spirit into its study and pursuit, and built upon this foundation the noble edifice upon which medical men may now rely in the hour of direst need. The most important truth of hydrotherapy, its primary action upon the nervous system, was clearly brought about by Winternitz, who showed that even in fevers this effect is paramount and the antithermic effect is secondary. As a teacher, his genial manner and clear presentation have conveyed the knowledge of the value of water in disease to students from every land, who have become missionaries of his good work. Physicians and nurses are sent to him for instruction from the Bavarian and Austrian armies. Winternitz has published over two hundred monographs and works, which, having been translated into every language, serve everywhere as beacon lights to the searcher after truth. As a practitioner his wonderful success is illustrated by the institution at Kaltenleutgeben, which has increased from eighteen patients in 1862 to two thousand patients in 1896. He created the first hydrotherapeutic clinic ( a part of the Allgemeine Universitats Klinik in Vienna) at his own expense. When the introduction of antitoxic therapeusis threatened the disparagement of hydrotherapy, as of all other therapeusis, this grand man, fortified by physiological, pathological, and therapeutic learning, clearly set forth the scientific truth that, while water possess no antitoxic virtues, it aided nature in its battle against the manifestation of toxemia, by improving cardiac action, vivifying the nervous system, and furthering the oxidation and elimination of toxic products, thus establishing more firmly than hitherto the scientific basis of hydrotherapy. This doctrine he had taught years ago, but its acceptance was slow; it is now almost universally accepted.

The application of cold water became one of the methods in the modern expectant treatment of acute diseases. The greatest progress in this direction was initiated by Ernst Brand, who, in 1861, published his remarkable results from baths of 65 F. in typhoid fever. The methodical use of these baths has become classical, and will probably remain so until specific antitoxic methods are discovered. Jurgensen, Traube, Liebermeister, Furbringer, Leyden, Ziemssen,Strumpell, Filehne, Naunyn, von Mering, Senator, Goldscheider, Leyden, Curschman, of the present generation, favor active hydrotherapy in febrile diseases, and place it at the head of all remedial agents, but unfortunately they have not given the Brand bath a fair trial. This is the most painful incident in the history of hydrotherapy. Despite the fact that in the eighth decade of the last century the most accurate statistics and bedside observations in the most reliable hospital (army) of the world had affirmed the life-saving value of the Brand bath in typhoid fever, and despite the further fact that these statistics were vouched for by the Imperial Statistical Bureau in Berlin over the signature of Professor Guttstadt, the German teachers did not subject this method to a fair (if any) trial in the civil hospitals and condemned it as barbaric, heroic, or otherwise reprehensible without actual trial. Condemnation of reformers in medicine and their persecution has not, alas, been rare in the history of our calling. Harvey was driven out of London, Semmelweiss was driven to a lunatic asylum, and our own gentle Oliver Wendell Holmes was ridiculed by the “professors of the great schools in Philadelphia.” Brand, after positive demonstration of the life-saving value of his bath, was simply treated with contempt and, like the great Harvey, obtained vindication in foreign lands (France and the United States). The author shall always regard as his best achievement the introduction of the Brand bath to his colleagues, and he is proud of the spirit of fairness with which American physicians gave it practical trial.

On its value in chronic diseases we have the testimony of many teachers, among whom is Prof. F. A. Hoffman, of Leipzig, who says: “Cold water is a therapeutic agent by whose correct application we may most surely and without danger of reaction exercise and invigorate the nervous system, and herein I seek its fundamental significance in the treatment of all possible internal diseases. I am convinced that in time all chronic diseases of the organs will be drawn into the domain of the bath treatment.”

For many decades Winternitz had stood alone in Europe valiantly battling for instruction in hydrotherapy. Erb, Charcot, and Semmola practiced and advocated it in their respective countries; they did not teach the technique, for the simple reason that they had not been taught this most important subject. They sent their patients to specialists in hydrotherapy. The latter continued to exist precariously in a commercial sort of manner; it was aptly named by Winternitz “the stepchild of medicine.” Suddenly there came a great revulsion. The reason thereof was the rise of the Naturarzte of whom Father Kneipp was the most prominent exponent. When the author visited Germany in 1890 he found magnificent institutions, like the Zimmerman at Chemnitz, drawing large clienteles. The enormous inroads made by these empirics upon the income and status of the medical profession was creating great alarm, as is evidenced by the plea of Professor Crede insisting upon the necessity of applying hydrotherapy and other physical remedies in the hospitals, and pleading for instruction in these branches in the universities. He claimed with clear discernment that “if physicians were better versed in these branches, the field of operation of many quacks would be greatly curtailed.”

The serious inroads of these empirics upon the interests of the medical profession led to the appointment of a “commission for the revision of medical examinations,” of which that eminent and practical teacher, Professor Kussmaul, acted as chairman. His report clearly set for the the alarming conditions which were existing and becoming more acute constantly, and suggested the remedy as follows: “It cannot be denied that the faith in prescriptions is waning among educated people, and that confidence in dietic remedial methods and in the curative power of water is in the ascendant.”

Even the lower strata begin to realize how much may be accomplished with air, water, and proper regulation of habits of life without the use of medicine. A distrust against even the most powerful and indispensable medicinal agents is becoming more pronounced in large circles. Water is the chief agent, which has won steadily growing confidence as a remedy, because, unlike every other, it may be utilized in varied and changing temperatures and forms of application, for the most varied therapeutic purposes. According to the correct and skillful selection of the procedure, it regulates the circulation and distribution of blood, the production of heat and tissue change, and influences the respiration and the nerves.

“The treatment by water has passed its childhood days, when it still staggered upon feeble limbs, and not infrequently did as much damage as is done by improper medication. Ripened experience and physiological knowledge have fortified the treatment and rendered it safe. Hydrotherapy, combined with diet, may undoubtedly bring about, or aid in, the cure of numberless acute and chronic diseases.

“Of hydrotherapy the young physician knows almost nothing when he leaves the university. Unfortunately he sooner or later may encounter discomfiture when an uneducated water doctor steps in and cures the patient after he has failed. Deeply chagrined and disappointed in his confidence in scientific therapeutics, he may pass into the camp of crude empiricism.

“Here lies a great gap in the education of our physicians; here lies the real cause of weakness in the contest for the favor of the public which sooner or later must be encountered by the physician with the layman who may have gotten experience in water treatment or be naturally adapted for it. A revision of our course of study must be made above all things.”

The effect of this vigorous arraignment of the whole profession for neglect of the most important remedial agents was magical. Clinics were erected in Berlin, Leipzig, Heidelberg, Breslau, Jena, and other schools; teachers made pilgrimages to Vienna, where the high priest of hydrotherapy had for years wearily preached the same doctrine. As a result of this response to a crying need, physical remedies obtained more recognition.

Today not alone do most medical schools on the Continent teach hydrotherapy, but the interest of this subject has awakened a literary activity in the special lines of physical therapeutics, of which hydrotherapy is the chief. A number of special journals are now published, of which the Zeitschrift fur physikalische und diatetische Therapie, by Leyden and Goldscheider, is the most prominent.

Thus has it come about that the “instinct of self-preservation,” that most potent of all factors in life, has accomplished what Winternitz and a few earnest and courageous men had failed to do.

In the Balneological Congress held in Munich in 1896, the chief of Professor Leyden’s clinic, Dr. G. Klemperer, gave a resume of the methods used in the clinic by advice and with the cooperation of Professor Leyden. He emphasized the fact that “the effects of hydrotherapy are derived from an extraordinary, quite incomparable excitation produced upon the nervous system, which is transmitted to various organs.” In this address he dwelt upon its value in neurasthenia, asthma, functional and organic cardiac, gastric, and interstinal disease, which have been referred to in the clinical portions of this work.

In Italy where the eminent Savonarola had early established water as a remedy by his work, “Tractatus de Omnibus Italiae Balneis,” a priest damaged its reputation by senseless enthusiasm. Pater Bernardo, living in the island of Malta, was the precursor of Kneipp, of whom so much is heard today. He practiced many of the same methods (walking upon wet grass and upon wet stones) and attracted all Europe with his “miraculous cures.” He was followed by Todano and Sangez, in 1722. The former paraded as “Medicus per aquam,” the latter as “Medicus per glaciem,” both filling their credulous patients with ice water, and rubbing them with snow and ice, while they fed them on three or four yolks of eggs a day. This quackery again caused water to fall into disuse among physicians. Its value ceased to be recognized until Gianini, professor in Milan, published in 1805 his work, “Della Natura delle Febri e del Migliore Metodo di Curarle,” in which he substituted baths of from five to fifteen minutes for Currie’s affusions in fevers, gout, and rheumatism. Thus the empirics caused an indifference to the remedial value of water to result, which continued for eighty years.

Italy was rescued later from indifference to hydrotherapy by the teaching and writings of many eminent men- Borelli, Baglivi, Bellini, Valisneri, Cyrillo. These, with Michelotti and Cocchi, were the forerunners of men like Cantani, Semmola, and Vinaj, who have in more recent times illustrated the value of hydrotherapy clinically and physiologically. Some of the most notable investigations upon the effects of hydriatic procedures emanate from Vinaj and Maggiora. Semmola, professor of therapeutics in the Naples University, whose lecture (1890) were translated into German with a laudatory preface from Professor Nothnagel, taught that “hydrotherapy stimulates cutaneous activity, and with it all functions of tissue change and organic purification, so that often real marvels of restoration in severe and desperate cases are accomplished. Unfortunately these remarkable results are more rare today than they were in the time of Priessnitz, of which I was myself a witness. The reason appears to lie in the fact that hydrotherapy has become the monopoly of the exclusively trade doctors, who treat the various maladies without strict selection of the hydriatic procedure in each case, etc. Hydrotherapy presents a truly rational treatment, and therefore certain and unfailing effects, unless the local processes have reached incurable limits (atheroma, visceral arteriosclerosis, etc.). In such cases, indeed, pharmacology alone is also powerless in its results.”

In one of the hospitals in Florence, Italy, the author saw the best douche apparatus in Europe in March 1900.

France- a general practitioner, Schedel, who studied hydrotherapy in Germany, was the first physician who demonstrated the value of cold-water applications in the building up of failing compensation in valvular diseases of the heart, and as a tonic in tuberculosis.

The great Magendie also increased our knowledge of the effects of water by physiological demonstrations.

Fleury founded a distinct school of hydrotherapy by the introduction of douches as the chief method, fortifying his clinical results by physiological and rational deductions. He claimed that cold douches are a reliable substitute for quinine in malarial disease, and that they are of great value in tuberculosis and anemia. By his indefatigable labors and physiological demonstrations, as far as the knowledge of the day enabled him, he gave an impetus to the systematic use of the douche, which is today recognized as the French method, and which has become famous through its advocacy and application by Charcot, Dujardin-Beaumetz, and others.

An incident occurring in 1839 furnished an interesting illustration of the status of hydrotherapy in France. Two regular practitioners, Engel and Wertheim, petitioned the French government for permission to open a hydropathic institution. The petition was referred to the French Academy of Medicine, which appointed a committee, consisting of Bouillieaud, Velpeau, and Roche. The last-named delivered such a tirade against hydrotherapy, characterizing it as “dangerous, unscientific, chimerical, and opposed to the simplest laws of physiology and pathology,” that the sixty members present made an adverse report. Permission being denied, Wertheim demanded a bedside test. Gibert and Devergie applied hydrotherapy in the Hopital St. Louis, and reported so favorably that permission was granted by the ministers. A few years later Scoutetten, who was sent to Germany By Marshal Soult to study hydrotherapy, reported that, “while it cannot be reckoned a universal remedy, the numerous permanent cures it has wrought in intelligent persons commend it to popular attention. The interest of humanity and medical science demand that a demonstration of the technique and action of hydrotherapy should be made in Paris under the eyes of able physicians.” This unbiased and sensible report gave a great impetus to the development of hydrotherapy among French physicians, to whose honor it redounds today.

France has steadily advanced in the development and practical application of hydrotherapy. The great clinician Charcot applied it constantly in his practice, and doubtless owed much of his remarkable success to the judicious use of water. He was in the habit of referring his cases to Keller in Paris, and to the hydrotherapeutic establishments of Divon and other rural resorts. In acute disease the missionary labors of Glenard, who learned the Brand method while a prisoner of war at Stettin, and of his fellow townsmen, Tripier and Bouveret, who have written an excellent treatise which has been translated into the German language by Pollak, are noteworthy. The scientific investigations of Roque, Weil, and A. Robin, on the effect of the cold bath upon urinary excretion in typhoid fever, have become classical. Today France is the stronghold of the Brand method. Hutinel, Guinon, Rendu, Johel-Renoy, and others, have emphasized the value of bathing in pneumonia and the exanthemata. “A prophet is not without honor save in his own country.”

The works of Dujardin-Beaumetz, Delmas, Duval, Beni-Barde, Glatz, and Charcot afford evidence of great activity on the part of modern French physicians in hydrotherapy for chronic disease.

Water-cure establishments did not until recently multiply in France as they did in Germany after Priessnitz, because the laws against lay practice are more stringent in France. This fact has caused a marked difference in the development of water institutions in these two countries. Physicians of scientific attainment entered upon the investigation of hydrotherapy in France with zeal, while in Germany the natural prejudice entertained by the medical profession against the empiricism of Priessnitz and his followers for a long time prevented educated physicians from attaching themselves to water establishments. Today the pendulum seems to have swung in the opposite direction, judging from the number of medical men who claim to be followers of the priestly water apostle, Kneipp. The “Naturarzt” is more or less protected in Germany, where he practices his crude art of healing unmolested, while in France the medical profesion is protected against these charlatans.

In England hydrotherapy has not obtained a foothold among physicians, despite the fact that some of our best works on the subject emanated from English authors in the latter part of the eighteenth and early part of the nineteenth centuries.

That English physicians are not at the present time better acquainted with the methods of Floyer, Currie, and Wright in the treatment of fevers is a deplorable fact, illustrating their neglect of medical history and inattention to the medical achievements of men whose labors were better appreciated in foreign lands.

Currie’s work was translated into several foreign languages, and his practice was introduced into the Vienna hospitals by Joseph Frank. Currie introduced affusions in the treatment of fevers, and this really pointed the way to the Brand method. In gout and convulsions, paralysis and tetanus, and other diseases he also claims to have had good results.

A careful search for the cause of the desuetude into which the use of water has fallen in England, despite its advocacy by its most eminent medical men in the seventeenth century, develops the fact that Floyer’s writings were so enthusiastic and convincing that many intelligent lay people espoused the methods advocated by him. Among these was a minister of the gospel, John Hancocke, who in 1723 wrote “Febrifugum Magnum, or Common Water the Best Cure for Fevers,” which reached seven editions in one year. The enormous influence of this work upon the lay people is explained by the popularity of his book. With natural aversion, English physicians neglected a remedy which had thus been lauded into popularity. Even such influential men as Pitcairne, Cheyne, and Huxham, who appreciated and advocated its use, could not establish a permanent position for it. As a result this valuable remedy, especially in its application to chronic diseases, fell into the hands of irregulars, who erected hydropathy into a system of treatment and still more decidedly estranged regular practitioners from water as a remedy. This practice and writings of Drs. Wilson and Gull, of Malvern, in more recent times, may be cited to confirm this statement.

Many years of active and careful propaganda will be required to regain the ground that was lost through the bitter opposition aroused by the writing of John Hancocke and his ilk.

It is a sad commentary upon the indifference to the history of medicine to note the neglect of scientific hydrotherapy, even in acute diseases which exists in England today. In the summer of 1896 the author visited one of the largest and most modern hospitals in London. Making the rounds with able and otherwise progressive physician, a case of typhoid was reached, which was receiving expectant treatment. When I asked if the Brand method or any positive water treament was used beside sponging, the attendant exclaimed, “Do you approve of such heroic measures?”

In a discussion of the treatment of fevers in 1895 by the British Medical Society, a general condemnation was meted out to cold baths, because “they are heroic.” Only one timid advocate was heard in their favor. But Prof. William Osler, of Baltimore, stated on that occasion that “were the Brand method more heroic still he would use it, because it saves life.” This incident occurred in the country which gave birth to, and in which lived and practiced James Currie, whose writing had inspired Brand!

When the author requested the editor of a prominent British medical journal to publish a plea for the more general application of water in disease, in February 1900, this gentleman protested that such a plea was not necessary, because the British literature on this subject was abundant. In order to convince this editor, the author requested the librarian of one of the largest medical libraries in London to furnish him the titles of all articles and works on pure hydrotherapy, written by physicians during the past quarter of a century. The number of this literary treasure reached eleven! It is gratifying to the author to state that since the publication of his “plea” in the Medical Press and Circular of London, that attention of practitioners has been directed to this valuable agent, and frequent reference to its use is now found in English literature.

In America the application of water in disease has until recent times been vague, and its advocacy rather timid, probably because the earlier textbooks on medicine were reproductions of works by English physicians, who, as I have shown above, have exhibited a singular indifference to hydrotherapy. The most earnest non-empirical advocates of water in disease in America prior to the author’s propaganda were Drs. Abram and Mary Putnam Jacobi, of New York, and the late Hiram Corson, of Pennsylvania, who illustrated its value in large clientele, and to whose writings I owe my earliest inspiration and example.

During the past two decades quite a change has been wrought in the attitude of American physicians toward hydrotherapy.

Dr. W. H. Draper, professor of clinical medicine, Columbia University, in an address on hydrotherapy before the New York Academy of Medicine, said: “In persons whose nutrition has been enfeebled by chronic disease, and in neurasthenia, hysteria, and hypochondriases, its good effects are very striking. It seems to be more effective than any treatment by medicine in stimulating the nerve centers, in restoring the equilibrium of the circulation, and in reviving the activity of the organic functions.”

In February 1889, I presented before the New York State Medical Society the first plea made in this country for the cold (Brand) bath in typhoid fever. It received only condemnation in the discussion which followed. In commenting upon this paper, the Medical Record of February 16th, 1889, said editorially: “It will be difficult to persuade the profession to adopt the heroic method of cold bathing.”

These discouragements were offset by the request from Dr. Austin Flint, in charge of the first division of Bellevue Hospital, to explain the technique of the Brand bath to his staff. And it was at once adopted by him and brilliantly continued by Peaboby, Ball, and James, in their clinics and lectures. In 1890 I read a paper in the New York Academy of Medicine, a report of which, published in the Medical Record, stated that “Dr. Alfred Loomis said he would take the first opportunity of giving this method a trial,” and “Dr. Delafield said that he has had no real experience with the Brand bath.” Both of these teachers began to teach this method at once, as I learned from reliable members of their classes. That their teaching had fallen on fruitful soil is evident from the fact that in 1902 Dr. Gilman Thomson’s textbook on practice stated that “the mortality from typhoid fever in the New York and in the Presbyterian Hospital had been reduced from sixteen to six per cent by the Brand bath.” And in 1903 the late Dr. H. P. Loomis reported to the Practitioners’ Society that “the mortality from typhoid fever in the New York hospitals had been reduced fifty percent by the systematic use of the Brand bath.”

Inasmuch as the mortality from this disease from 1878 to 1883 in the New York hospitals had been calculated by Dr. Delafield to be in 1300 cases 24.66 percent , it is evident that the Brand bath had saved about one thousand lives in the hospitals of New York alone during the past fifteen years. Since the method may be more perfect in private practice, the saving of life would seem enormous. That this was the result of instruction in hydrotherapy of typhoid fever “goes without saying.”

The Brand method is at the present time practiced in the best hospitals of this country. I am able to make this statement positively, because I have addressed letters of inquiry regarding their present attitude toward the Brand bath to the most prominent clinicians, and the replies are unanimous in the same vein as the following just received from the professor of practice in Columbia University and physician to the Roosevelt, Bellevue, and other hospitals: “In reply to your favor of the 13th I beg to say that I am continually using the Brand treatment in typhoid fever and still regard it as of the utmost value. My views as to its efficiency have not changed in the past few years. I remember very well your introdution of the method, and that we are indebted to you for many earnest and valuable contributions upon it, and especially for your emphasis on the necessity for using it thoroughly.” How different is the response to a similar inquiry (“Umfrage”) sent out by the “Deutsche Klinik” in the summer of 1907! Only one of these professors in Germany referred to the bath, and he condemned it as barbarous. A practitioner who had the temerity to intrude himself into this august symposium stated that he had personally witnessed the brilliant results of Brand in the Franco-Prussian War, but he had abandoned it because it did seem so barbarous. Was ever maudlin sympathy more flagrant! The German- Brand- has been vindicated by American physicians, history has repeated itself! The Brand bath has been demonstrated as the most valuable method in typhoid fever by the German Army surgeons and later by the enormous statistics of Medical Directory Vogl, of the Munchner Garrison Hospital, where over eight thousand cases were recorded during forty years under all the prevailing methods of treatment. The lowest mortality was from the strict Brand bath, 2.7 percent; the highest mortality was from the expectant treatment, 20.7 percent. What the mortality of typhoid fever is in the hospitals from which the “Umfrage” was answered does not appear; these professors simply give their “views” without corroborative evidence. The American professors offer not only their views but furnish clinical proof of their correctness.

Hydrotherapy is now regularly practiced in many of our metropolitan hospitals in acute diseases.

The author introduced its systematic application for chronic diseases in the Montefiore Home for Chronic Invalids in 1887. Many other institutions have since that time had douche apparatuses constructed, and are applying water successfully in chronic diseases. The results have been most favorable in lunatic asylums, because in these institutions it is applied systematically and with precision. Thus an epoch in hydrotherapy has been inaugurated, which is unique in the history of this subject.

Other evidences of awakened interest in the subject have been elsewhere referred to.

Many American health resorts and sanatoria practice hydrotherapy in the old-fashioned hydropathic manner. Recently the German practice of attaching hydrotherapeutic establishments to good hotels at health resorts has been initiated in this country. The Lakewood Hotel (winter) in New Jersey, the “Mecklenburg” of Chase City, Va., the Homestead at Hot Springs, the Palm Beach Hotel in Florida , and the Hotel El Paso de Robles in California have obtained complete hydrotherapeutic equipments, which are superior in efficiency for the correct application of temperaure, duration, and pressure, to those which the writer has seen in Germany or France, and which are under the direction of educated physicians.

The author has established a hydriatic department in the Riverside Baths, to which many physicians and dispensaries send obstinate cases for treatment, the attendance at which has inceased from 2,146 in 1895 to 16,012 in 1902- incontrovertible evidence of the increasing appreciation of the value of hydrotherapy. Bellevue Hospital has also followed this initiative. The Park Avenue Hydriatic Institute of this city, which was inaugurated in 1892 for the purpose of promoting the use of hydrotherapy in chronic disease, has administered over 100,000 treatments to patients referred by over one hundred physicians. It is to be hoped that such institutions may multiply in our cities, and that they may always be under the direction of educated physicians, and not be “run” by masseurs and bath nurses, who have so often brought hydrotherapy into disrepute among physicians.

These evidences of growing appreciation of the merits of hydrotherapy among American physicians offer to the author a gratifying finale to this brief historical resume of the subject.

Conclusion: An unbiased study of the entire history of hydrotherapy develops the fact that the great clinical teachers of the present day reaffirm their faith in a method of treatment which has received the highest sanction from Hippocrates, Asclepiades, Celsus, Hufeland, and Currie. For a long period the medical profession had received its chief information on water from men who, though honestly striving for the propaganda of water as a remedy, were regarded as enthusiasts whose views were probably tinged by prejudice in favor of their methods of practice. Some faint shadows of the bitter but just prejudice which Priessnitz and Hancocke and their ignorant and blatant followers had aroused in the minds of medical men still seem to fall upon those who attempt to secure attention to hydrotherapy. To remove this fallacious and mischievous idea is one of the aims of this work.

The testimony of clinical observers, not connected with hydrotherapy as a speciality, has therefore been cited to define clearly its status at the present time, as evidenced in the clinical portions of this work.

History has repeated itself here as in other departments. The opinions of the most judicious, philosophical, and successful physicians of past ages have been sustained by the judgment of this enlightened era.

The student of the history of hydrotherapy must observe that it has passed through many cycles in the estimation of physicians. It would be profitable to ascertain the causes of these fluctuations in order to avoid their adverse influence in the future.

Just as among the ancients we find among the most renowned physicians the most active advocates of water as a remedy, so does its history in modern times develop the same fact. The simplicity of this remedy, however, antagonized the pedantic and self-important members of the profession. When laymen, who must have learned its value from observing its effects in the hands of physicians, espoused it, the latter became entirely estranged. Thus did it come about that Priessnitz created a sect, the hydropaths, whose influence for the popularization of the treatment was in inverse ratio of its adoption by the profession. And this blighting effect of the empirical espousal of water as a remedy is today mainly responsible for the aversion which many physicians feel to its adoption. This aversion is least pronounced in France, because that country has not been so extensively invaded by the water quack, and its hydrotherapeutic institutions are under the care of educated physicians. In Germany, too, where Ziemssen, Brand, Jurgensen, Winternitz, and others have labored to prepare the scientific basis for hydrotherapy, prejudice is rapidly disappearing among the rank and file of the medical profession. This is also the case in Italy.

In England and America, however, much agitation will be required to induce physicans to wrest this valuable therapeutic agent from the hands of the empirics, to whom their indifference appears to have delegated it. Great progress has, however, been made since the publication of the first edition of this work. Very recently Dr. J. H. Kellogg has published a large, almost encyclopaedic work on “Rational Hydrotherapy,” which is exhaustive of every detail and adds a brilliant contribution to American medical literature.

Are we, as medical men, just to ouselves or to those who intrust their lives and health into our keeping, in maintaining an indifferent attitude? Calm reflection must bring us to realize the fact that the application of water in disease is the most orthodox therapeutic measure in medicine, having (as I have shown) been fully treated by Hippocrates, and taught by the most eminent and judicious men who have illuminated medical history, and that therefore hydrotherapy deserves to be liberated from the absurd and undeserved stigma of relationship with empiricism.

The excessive medication, combined with blood-letting, which, as referred to above, characterized the practice of medicine in the early part of this century, gave way to what was termed therapeutic conservatism. The writings of Bigelow and Flint in this country, and of Dietl, Wunderlich, and others in Europe, developed the expectant method of treament, which aided the system it its battle against disease instead of fighting the latter at the expense of the former. The therapeutic nihilism resulting from the abandonment of excessive medication causes many physicians, especially in Germany, to shrug their shoulders when discussing treatment, while they glow with enthusiasm when the bacteriological or pathological aspect of the case is considered. As a result of this indifference to therapeutics, a sect of ‘nature doctors” (Naturarzte) has appeared, who propagate their therapeutic ideas by lectures, books, and periodicals, and thus succeed in driving the physician from the field. The empirics like Priessnitz, Hancocke, Oertel, Pater Bernardo, and their ilk are today represented by the followers of Kneipp, who used cold water in the most crude methods, and combined it with herbs and teas, but chiefly depended upon abstemiousness in diet and mode of life. The water procedures of Kneipp are based upon the idea that the body must be forced to produce its own reaction, a correct principle if not indiscriminately applied to patients whose reative capacity needs gradual training. To neglect of the latter may be ascribed the numerous sad failures reported by reliable observers, but never published by Kneipp enthusiasts. In this country there are several “Kneipp cures” which eke out an existence. It would seem that the practical American mind may by proper instruction be held aloof from this fad.

The Lesson: The study and judicious application of hydrotherapy in regular practice will accomplish more for the protection of the people against the quacks than prosecutions through legal channels. It is not wise, however, to treat the doings of these people with contempt and to shrug our shoulders when their “cures” are brought to our attention. The patient cares little how he is healed; he certainly prefers to be cured by the empiric to being kept in continous pilgrimage to the scientific doctor’s office. A correct diagnosis does not interest a sick man so intensely as correct treatment.

Necessity for Instruction in Hydrotherapy: The author hopes to bring the medical profession to a realization of the danger which by reason of their indifference threatens them and their clientele, by presenting the above brief resume of the history of water as a remedy. He would urge most earnestly a careful, conscientious, and thorough investigation of its physiological and clinical claims, and the introduction of means for better instruction of medical students in the theory and practice of hydrotherapy. Happily some of the most earnest teachers in Germany are now making an effort in this direction.

The addition of hydrotherapy to the clinical curriculum has recently been agitated in the German Parliament, and has culminated, through the intelligent recognition of Director of Education Althof, in the establishment of a chair on hydrotherapy in the Berlin University, to which Professor Brieger, the renowned clinician and bacteriologist, has been assigned.

The medical director of the Bavarian army, Dr. A. Vogl, has recently recommended the instruction of medical officers of the army in hydrotherapy, and has induced his government to send a number of army surgeons to the Hydrotherapeutic Clinic of Professor Winternitz, in Vienna, for this purpose.

Vogl regards “the insufficient education of medical men in physical therapeutics, especially in hydrotherapy, as a serious defect, which injures physicians in their earlier practice, and for which it is difficult to compensate later.” He justly hold that “hydrotherapy should be taught in its entirety, as Winternitz has done, upon a physiological basis. By lectures and clinical demonstration it should be brought before the student just as other therapeutic agents and methods are offered to him- as obligatory branches of study. When this is done, hydrotherapy will become the general property of all physicians, and not be practiced as a special and distinct method.”

“Here lies a great gap in the education of our physicians; here lies the real cause of weakness in the contest for the favor of the public which sooner or later must be encountered by the physician with the layman who may have gotten experience in water treatment or be naturally adapted for it. A revision of our course of study must be made, above all things.”

“The teacher of clinical medicine has now so many duties to perform in his work of instruction that no time is at his disposal for familiarizing his students with hydrotherapy. In order to instruct them more than superficially, distinct chairs and clinical divisions are required, in which appropriate cases may be treated by hydrotherapeutic procedures. These lectures could be combined with others on balneology and purely dietetic treatment, but, for Heaven’s sake, let not this professorship be connected with that on pharmacology!”

As has been referred to above, this clear presentation of facts has inaugurated an epoch in medical teaching in German. The humane and scientific spirit of the medical profession was sustained by that most potent of all influences on human action- the laws of self-preservation.

In this connection the views of Professor Vierordt, of the Heidelberg University, are of great interest, as showing that the seed which Winternitz many years ago sowed is now about to reach fruition in his own country. Vierordt says: “All signs indicate that hydrotherapy will succeed in obtaining a distinct and clear position in medical science, and that it will correspondingly reach the consideration in medical instruction to which it is entitled. Hydrotherapy can be taught only practically, because it must be applied more individually than any other therapeutic agent.”

Professor Vierordt has established an arangement for baths, douches, massage, etc, in connection with his polyclinic, where trained attendants apply them under strict medical supervision with regard to temperature, duration, and force. One of his assistants resides near the institution and watches over its work. “All expectations have been amply fulfilled. It is utilized for instruction of small groups of students in the polyclinic, who thus learn practically, under the personal supervision of the professor and his assistant, the indications for and application of the more simple and useful hydriatic methods. Experience gathered in this small institution warrants the recommendation that facilities for ambulant hydriatic treatment should be connected with every medical polyclinic, for the benefit of patients and students alike. Hydrotherapy should be included in medical instruction, not as a specialty; it should be brought completely into the domain of our scientific curative agencies by the careful selection of procedures and of cases to which it is adapted.”

In Leipsic Professor Windscheid and in Cologne Professor Mathes teach hydrotherapy.

In Dresden Professor Crede also insists upon the necessity of applying hydrotherapy and other physical remedies in the hospitals.

From recent correspondence with Professor Brieger it appears that this clinic had been enlarged twice by reason of the increase number of students. In a recent letter Profesor Brieger writes: “I rejoice that hydrotherapy is, under our guidance, gaining ground in America, and that it may soon become the common property of physicians as it it with us.”

In America also a plea for instruction in hydrotherapy has been published. Dr. Frederick Peterson, chief of the Neurological Clinic in the College of Physicians and Surgeons, Columbia University, wrote: “Many of the scientific principles of hydrotherapy have already been estalished, but it would be well worth while to carry out at a few of our clinics and in the physiological laboratories some of the elaborate experiments with water which are frequently resorted to for the purpose of demonstrating the uses of new drugs. It would be well if some of our large schools would initiate a course of lectures on this subject.” This plea of a justly eminent alienist, like those of the author, remained unheeded for ten years.

With regard to the teaching of hydrotherapy in our schools, it is unnecessary to add anything to the pleadings of recognized teachers, with whose views the author is in entire accord. My personal intercourse with many physicians affords illustration of the truth of their statements and the correctness of their views. I would most earnestly commend to the consideration of the faculties of our progressive medical schools the example of the Universities of Vienna, Heidelberg, Berlin, Jena, and Leipsic.

Much time that is now wasted in teaching the properties and application of drugs, which are rarely used in practice, could be profitably devoted to the clinical study of the action of the most powerful remedial agent. In view of the importance of the branch, the course adopted by Columbia University, which makes hydrotherapy an obligatory study in its clinics and lectures, is worthy of imitation. Twenty years ago the Dean of the faculty of the University, who was urged by one of its most eminent professors to add hydrotherapy to its curriculum, regretted that this course was impossible because the curriculum was overcrowded. It seems that by proper pruning of the latter the chair of hydrotherapy has been made possible under the present administration. A hydrotherapeutic institution, equipped with hot-air boxes and a douche-table elsewhere illustrated, and other facilities for the administration of water in chronic diseases have been added.

The senior class, divided into sections of ten or more, receives clinical instruction in the hydrotherapeutic department of the Vanderbilt Clinic on Monday and Friday afternoons. The first half of the clinic is devoted to demonstration of cases, the diagnosis is briefly dwelt upon, and the pathology and etiology are referred to with a view to point out the therapeutic indications. The aid of hydriatic measures and the reason for their employment, with or without drugs, in the concrete case are clearly gone into, and the patient is treated in the presence of the students, who are encouraged to ask explanations of any obscure points. The latter half of the clinic is devoted to demonstration of the technique of hydriatic procedures, and students are requested to practice them just as they are taught bandaging or other manual procedures in other clinics. The clinic is under the charge of a chief, and two assistants who write the histories, demonstrate procedures, and “quiz” the students. A trained attendant treats cases under their direction on Mondays, Wednesdays, and Fridays from 1 to 4 P.M. Only males are treated, for obvious reasons. Female patients and cases not required for teaching are referred to the Riverside Association Hydriatic Department, which is under my direction , and treats about fifty cases daily. Wednesday afternoon is devoted to experiments in hydrotherapy and instruction of the clinical staff. A course of lectures upon the principles and practice of hydrotherapy is also provided for during the latter half of the semester. The final examination includes not less than two questions on hydrotherapy.

America stands foremost now in positively securing instruction in the application of water in disease for the rising generation of physicians. Columbia University is the only school in which hydrotherapy is made an obligatory study. The author cherishes the hope that other schools may follow its initiative for the promotion of the interests of medicine and the consequent amelioration of human suffering.