For all ordinary medical and pharmaceutical purposes, the common water of springs, cisterns, and wells, is sufficiently pure. Where any of these is strongly impregnated with either mineral or organic substances, pharmaceutical uses require it to be purified, either by filtration through a bed of charcoal and sand, or by distillation. Filtration is sufficient in the majority of instances, but requires that the sand of the filter shall be washed frequently, and the charcoal renewed by frequent washings and heatings. Distilled water is the purest, and therefore is preferable for all pharmaceutical uses. The pharmacein readily obtains an abundant supply of it by taking the trouble to attach a still to his vessel in the ordinary operations of decocting and evaporating.

The uses of water as a menstruum in pharmacy, will be spoken of elsewhere; while at this place its remedial uses will be discussed. And in this article no reference is had to various medical springs, which are pressed upon the attention of the public with such marvelous laudation. Some of these may be passably useful; but the majority of them contain epsom salts, salts of magnesia or lime, or similar ingredients, which deceive the invalid, while steadily making him a dyspeptic and bringing on emaciation. It is safest to say that the great benefits obtained at mineral springs, are to be attributed to the regulated diet, outdoor life, agreeable company, and relaxation from business, while the minerals in the water play an inconspicuous part in the restorative process. This is proven by the fact that those who reside in cities, and use mineral waters artificially prepared, or brought from some favorite spring, fail to derive benefit from such medication, but rather are among the most pale-faced, hypochondriacal, and steadily-failing classes of invalids. Inwardly, the use of water is mainly for the purposes of quenching thirst; in other words, of keeping the vascular apparatus suitably distended by a proper supply of fluid. It is the grand diluent of the system; and though, at one period of Allopathic history, it was strenuously denied to all classes of fever patients, a larger prevalence of common sense now directs its use in all such cases—with the simple restrictions of not allowing it to be too cold, nor to be used in excessive quantities , at a time. These restrictions are equally necessary among the well; for it is always a violation of the laws of health to use iced waters, which so suddenly lower the temperature of the stomach as to endanger its safety, as well as to arrest digestion and interfere with the heart’s action; and it is far better to drink small quantities at short intervals, and only so fast as the absorbents can take it up, than to use large draughts and oppress the stomach with them. Much fluid, of any temperature, can not properly be used during or soon after a meal; as it dilutes the gastric juice, and thereby retards digestion. As a menstruum associated with remedies, its therapeutical influence depends largely upon the temperature at which it is used, as has been explained in the department of Therapeutics.

With express reference to its curative action, water is employed more extensively outwardly than inwardly. This has been done from the earliest recorded histories of man, as well among barbarous as among civilized peoples; and though our Hydropathic neighbors would claim a sort of monopoly of its use, they but run to an extreme which physicians from the age of Hippocrates have avoided with much greater judgment and discretion. Indeed, the Hydropathists almost continually abuse this excellent and indispensable agent; and apply it so lavishly and indiscreetly as frequently to induce extreme emaciation; to overwork the skin, and divert to it (in the form of boils and other eruptions) excretory substances which should have been eliminated through the liver and other emunctories; and in various ways to reduce the patient by excesses in ablution, and by forcings of the perspiratory functions, till they are themselves compelled to desist and leave overburdened Nature to rally. I am well aware that an especial merit is claimed in the ability thus to induce “crises,” and so does Allopathy claim a merit in the use of her drastic cathartics; but depletion by the skin is equally prostrating with depletion by the bowels, (§187.) Nature abhors all such disregards of her mild processes, and neither method of proceeding has the least foundation in sensible Physiology.

Externally as well as internally, the temperature at which water is employed largely determines the character of its influence. Its impression, at all times, is more purely physical than distinctly remedial; and hence its physical impressions when quite cold, lead to widely different results from those made by it when quite warm. The curative part played by the vital force (§45) is also prominently noted in the use of this agent; whence a consideration of the temperature is of more consequence than that of the water alone. For general convenience, baths are usually divided into classes; though all such divisions must of necessity be arbitrary. The average warmth on the surface of a healthy person is taken as a sort of standard, and a convenient classification will be as follows:

Cold Bath, . . 33° to 55°.

Cool Bath, . . .55° to 65°.

Tepid Bath, . . 65° to 85°.

Warm Bath, . . .85° to 95°.

A temperature above 95° would be a Hot Bath. The state of the surface in each particular patient, would to a great extent determine the sensation caused on him by any bath; as when one in typhoid fever pronounces a tepid bath of 80° cool to his hot skin, and one in anaemia calls a heat of 60° quite warm. Nevertheless, with the standard of health to guide us, the above classification will be found generally applicable.

Cold Bath, 33° to 55° F.— Baths within these ranges act suddenly and powerfully in narrowing the caliber of the superficial capillaries, as cold always does. Such contraction physically forces the blood from the surface, as effectually as pressure would force water from a wet sponge. While this impression lasts, therefore, the outward circulation is reduced, and the inward accumulation of blood proportionately increased. This inward recession stimulates the heart and larger arteries to a renewed and more vigorous exertion, and they at once begin the labor of returning the surplus blood to the surface. If the cold application is discontinued in a few moments, this arterial effort is likely to be successful. Reaction then takes place, as from any other form of moderate shock; and a rush of blood to the surface, with a vigorous glow upon the skin, will ensue. This reaction is both hastened and heightened by friction. The good to be derived from this bath, is to be found in the promptness and completeness of the reaction that follows it; and when this is thorough and speedy, the glow it causes will prove tonic to the surface and invigorating to the locomotor muscles. In persons of robust frames and dense structure, the reaction is likely to be of a desirable character, and such people commonly enjoy this bath; and sometimes thin people have so much muscular density with nervous activity, that they also use it to advantage. But in all cases, the use of water at these temperatures secures an outward flow by first goading the inner vessels, and acts more as a provocative to than an assistant of Nature; whence the cold bath always makes a temporary taxation upon the frame, and reaction from its disturbing impression is at the best an expenditure of just so much vitality.

When the frame is feeble, the heart feeble or suffering from organic disease, the large blood vessels weak, and the capillaries inclined to sluggishness, the power to react is greatly diminished. Extensive accumulations inwardly must of necessity follow the use of a distinctly cold bath, under such circumstances; and unless artificial measures of a firm character are at once brought to bear to secure reaction, congestion more or less complete must ensue. And even with the best help that can be rendered by suitable stimuli, a frame in any of the above conditions will suffer too severe a shock by such a bath; the best reaction that can be secured will be accompanied with oppression in the lungs and heart, loss of appetite, and a feeling of prostration; and sometimes no reaction can be obtained till serious mischief has been done. It is for such reasons that a true cold bath is inadmissible in cases of typhus, scarlet, and diphtheritic fever; in inflammation of the brain, lungs, liver, kidneys, peritoneum, uterus, or other internal organ; or in any case where distinct feebleness of capillary circulation is either present or threatened. This catalogue includes the surgical use of cold water, ice-bags to the head and spine in the large variety of cases where they are now employed, and all continuous applications of this kind over even a small extent of surface, as upon the head in brain fever. Such measures induce local stasis: and by them the healing of a wound is delayed, and exhaustive suppuration is fostered; the coma of brain fever is prolonged, and the danger of hydrocephalus increased; the collapse of cholera is hastened, and the painfulness of its spasms increased by the disturbance of the spinal cord; and other mischiefs of this class are insured. These views are contrary to current opinions; but the teachings of physiology, and the results of cold irrigations in army and hospital surgery, abundantly bear out these statements. Wherever substantial good has resulted from such applications, even upon an actively inflamed surface, it has been owing to the temperature of the

water being cool rather than cold, and to its being renewed only at such intervals as allowed the wetted cloths to acquire a tepid warmth; whence the benefit is really due to the last temperature, and therefore it had better be the one selected at the outset.

Cool Bath, 55° to 65° F.—Within this range of heat, a bath is but moderately contracting, induces a mild and temporary in- flux of blood, and is quite sure to be followed by a full and pleasant reaction in any person of ordinary health. Being lower than the accustomed temperature of the surface, it absorbs a fair amount of heat without reducing the warmth to too low a point; and it usually leaves the skin slightly relaxed, with a sufficient freedom of capillary action to impart a feeling of vigor. The nervous peripheries at the same time feel soothed and strengthened; and all ordinary excitement and internal pressure of blood are likely to be much abated by this bath. Very prostrated conditions, however, offer to it the same kinds of objections as pertain to the previous bath; for the loss of power in such cases is so great, that a bath of 60° to such a patient is likely to have the same effect (relatively) as one at 40° would to a person but moderately feeble. The cases to which this class of applications is most suitable, are those of fever other than typhus, typhoid, diphtheritic, and erysipelatous; local inflammation (not congestion) with fever, fatigue, and sleeplessness or nervousness in persons of pretty robust frames. By most persons this bath is called the cold bath.

Tepid Bath, 65° to 85° P.—An average warmth of 80° probably represents that at which the tepid bath is most commonly applied; and below 70°, it might more fairly be termed lukewarm. At about 80°, it is a mild yet efficient relaxant, as well to the capillaries and nervous peripheries as to the sebaceous glands. It promotes perspiration, enlarges the caliber of the superficial blood vessels, secures a full afflux of blood outwardly, relieves internal engorgements, and greatly soothes the entire nervous system. The influence it exerts is mild, and in no sense perturbative; but is none the less extensive and positive. In all forms of fever it is altogether preferable to any other bath; for it is below the heat of a fevered surface, and yet is not below that of the healthy skin, whence it absorbs surplus warmth without reducing the temperature under a normal standard. Leaving the tissues gently relaxed, and the perspiration reestablished to a fair extent, it has a marked power in relieving the frame of accumulated skin excretions, and in obtaining a more natural balance in the bodily heat. Reducing the temperature by a proper amount of absorption, depurating the skin, and procuring capillary softness and distension, it first obtains a large afflux of blood from any internal organ that may be in a state of inflammation, and gives a relief to the nervous system that is of the most desirable character. So long as its influence lasts, (which varies from one to several hours, according to the circumstances of the case,) all external febrile excitement measurably abates, the patient becomes calm and disposed to sleep, and a wandering mind is usually restored. These general facts at once indicate the many maladies to which this bath is applicable, as typhus and typhoid fever, (for which it is the only proper sponge bath;) bilious, scarlet, erysipelatous, rheumatic, catarrhal, and all other forms of fever; phrenitis, pneumonia, hepatitis, and other internal inflammation; febrile restlessness, as a powerful adjunct to the inward use of diaphoretics; and in all cases where the surface is hot and dry, and the patient irritable. Even when the more acute symptoms are passing into a state of feebleness indicating the need of internal stimulants, the tepid sponge is still advisable over those portions

of the surface that are unduly warm; though it should give way to the hot bath when actual congestion has supervened internally. Another advantage in this bath is found in the frequency with which it may be repeated in cases needing it; for while twice in twenty-four hours are commonly sufficient, (avoiding its employment in the morning, if the febrile excitement have in a measure subsided,) it may be used three or four times a day, if a hard pulse and rapidly accumulating heat indicate it. With due care, such frequent repetitions of this bath relieve rather than weary the patient. The local use of the tepid bath is to be guided by the same facts as its general use. For all acute inflammations, it is the best; and though commonly secured in the form of a poultice, may be employed as a simple sponge. And in acute inflammation of the brain, where the common practice has been to use quite cold applications, those of a tepid grade are altogether preferable— absorbing all proper amounts of heat, inviting the blood outwardly from the brain rather than pressing it inwardly upon it, and directly soothing the nerve structures. The tepid bath is not suitable to strong local or general congestion, to flaccidity of the structures, a cool surface, a tendency to colliquative erspiration, threatening gangrene, or chronic reduction of vital energy.

Warm Bath, 85° to 95°.—Hot Bath, 95° F.—Baths of these two grades may be considered together; for a temperature of 90° is stimulating and relaxing to the surface, and the stimulation increases with the increase of temperature. A heat of more than 100° is rarely employed. Such degrees of warmth strongly arouse the capillary circulation; and are employed chiefly as a local stimulant over seats of congestion, and to relieve pain by promoting a positive outward circulation from a congested organ. These baths are hence usually restricted to flannels wrung from hot water and laid over the suffering part, as the bowels, bladder, uterus, lungs, or kidneys; and these are renewed every few minutes, as the temperature falls from hot to tepid. For all circumstances of this class, as well as in local rheumatism and neuralgia accompanied by partial congestion, such applications are of great service; and the same may be said of their more extended use in spasmodic difficulties arising from congestion, as around the throat in both membranous and spasmodic croup, to the whole body (placing the patient in a bath of the water) for most forms of infantile convulsions; and even for the spasms of cholera and the agitations of delirium tremens. The bath is rarely used in the two maladies last named; but a distinct hot bath, as a companion to suitable internal medication, is often of marked value. When the skin is cold and clammy, a hot bath is not advisable, except as warm water is used to make washes of the strongest stimulants; but when perspiration is excessive and warm, as in the peculiar flashes of heat and sweat of some women about the turn of life, a warm bath is among the most suitable means for giving steadiness to the arterial action of the surface.

Partial baths are many times used, of the tepid, warm, and hot temperatures; among the most valuable of which is the sitz bath.This consists merely of sitting down into a tub or regular burdette properly filled with water of the warmth selected. Usually it is fairly warm or nearly hot, and is of great value for relieving the congestion and suffering of acute dysentery, acute inflammation of the bladder or kidneys, or neuralgic and rheumatic tenderness of the womb and other female organs. In such cases, the temperature can be borne pretty warm, and the bath needs to have more hot water added to it from time to time. The patient should be well covered while using this bath: and may sit in it from ten to thirty minutes, according to circumstances, using diffusive and diaphoretic teas meantime. A former Hydropathic practice, greatly lauded by that fraternity, was to use a cold sitz bath for lying-in women, an hour or so after delivery; but I must proclaim against this as a violent procedure, and one that perhaps never fails to leave chronic pelvic congestion and prolapsus for months or years.

Pack Baths

This kind of bath consists in wrapping the entire body in a sheet wrung out of water. The clothing of the patient is all to be removed, the wet sheet laid upon a firm mattress, the patient laid upon the sheet on his back, the sheet turned up over him and wrapped around his limbs so as to come in close contact with the surface, and one, two, or more blankets laid over him and closely tucked around him so as to keep in the accumulating heat. The real object of this bath is to secure and maintain a tepid warmth about the entire body; and hence it is desirable always to wring the sheet out of moderately warm water, so that the patient may get wrapped in it before it gets below the tepid heat. The Hydropathists are too largely in the habit of employing the sheet wrung from cold water, thus giving to the body a strong shock under circumstances where the patient is deprived of all muscular motion by which to aid reaction. In feeble persons, this shock may prove serious; while in all cases no benefit accrues till the sheet has become warmed and reaction has been secured; therefore common sense dictates to begin the operation at that temperature from which the patient will derive advantage from the first moment of application.

This pack steadily and largely relaxes the surface, absorbs excessive heat, enlarges the capillaries, and invites an outward flow of blood, relieves the internal organs from irritable accumulations, depurates the skin by an abundant perspiration, quiets nervous agitation, and promotes the absorption of internal effusions. Under its influence, the pulse softens and becomes fuller and slower; the patient rarely fails to become drowsy, and presently to fall into a deep sleep; and an abundant perspiration breaks out. Thus its action is similar to the tepid sponge bath, being much more profound, as it is also more continuous; and it is usable for the same general class of cases to which the tepid bath is applied. Properly employed, it is a searching and valuable measure; but may be, and often is, continued too long for the welfare of the patient. The case which is obtained from it, and the quiet sleep into which the patient passes, are liable to deceive the nurse and to tempt her to continue the bath till the patient awakes. This may not be

for one, two, or even four hours. Sleep ensues as a consequence of general relaxation; and to allow a patient thus to repose in the wet sheet, is to secure excessive relaxation, exhaustive perspiration, and a most unwarrantable wasting of his strength. (See Therapeutics, §§ 55, 187.) A due regard for the welfare of the sick will never, under any circumstances whatever, allow such a bath to be prolonged in this manner; for while robust frames, and cases of rheumatic fever, may merely feel tired after being removed from it; those of slender build, and cases of pneumonia, meningitis, puerperal fever, and similar maladies tending to congestion, will be exhausted to an extent that is not advisable, even if it be not utterly reprehensible. Sometimes such persons will seem greatly improved after such a long pack, and the physician and friends will be much elated with the success of the application ; but the true condition of the patient is probably overlooked, and is not realized till he is found to be sinking from the sheer inability of over-relaxed arterial and nerve and fibrous tissues to rally a proper degree of tone.

Two rules should always be observed, in order to the successful use of this pack; first, to give the patient some diffusively stimulating tea before and during the bath, to sustain the inner organism; second, to discontinue the bath when a fair perspiration has appeared on the face, whether the duration of the bath itself has been long or short. The patient, being removed from the bath, is to be well dried and placed in a fresh bed. By the observance of these directions, the tepid pack will prove a very valuable measure; though one that should not be used too frequently, being an exertion to the patient as well as to the nurses. Sometimes the wet pack is made a little stimulating by employing a blanket instead of a sheet, the woolen fibers causing a slight mechanical excitation. Partial packs, called compresses, are much used for local difficulties, such as achings of the back, weight and pain through the loins, irritation of the respiratory passages, and similar cases. In such instances, it is most common to wring a narrow and soft towel out of cool water, wrap it about the part, cover this with two layers of a broader and dry towel, and wear it during the night. Both general packs and local compresses may be made powerfully medicinal by the addition of either stimulants or relaxants to the water. Relaxants are rarely used for general packs, but may be of service in acute inflammatory troubles; but the use of such agents as xanthoxylum, polygonum, or capsicum in this manner, makes the most powerful measure that can be employed in cases of profound congestion, as cholera, the last stages of malignant dysentery, etc. The stimulant may be applied to the surface as a wash, and the tepid pack then used, as a method often preferable to adding the stimulant to the water of the pack.

One general rule should be observed in the use of any bath, whether sponge, plunge, pack, or vapor, namely: Never to employ it less than one hour before a meal, nor less than two hours after one. A disregard of this rule will greatly interfere with digestion, and produce more harm than the bath is able to do good. And if the stomach contain undigested food, no matter if this have been taken several hours before, the bath should not be used till the contents of the stomach have been thoroughly evacuated.

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