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by Dr Reinhard Bergel
Types of Hydrotherapy
Full Immersion Bath: One of the simplest forms of hydrotherapy, available in nearly every home because of the bathtub, is the immersion bath. Depending on the temperature of the water, these baths are called neutral or cold, cool and hot.
Sitz Bath: A sitz bath is a method of applying water to the mid-portion of the body, especially to the perineum and the areas adjacent to it. The temperature of the water may be as low as 8C/46F and as high as 40C/104F. At these extremes, exposure will be brief. Since one of the chief values of a sitz bath is prolonged application of water at a comfortable temperature, the bath is usually given in the range of 36C to 40C/96F to 104F.
Neutral Bath: Because the temperature of the major part of the body's surface is about 33C/93F, water at a similar temperature produces comparatively little change in the body's physiology. Likewise, a variation of a few degrees either below or above this temperature exerts but little influence on the body's activity. The range of relative thermal indifference lies between about 32C/90F and 36C /97F; within this range, the production and loss of heat is relatively small, and there is no definite impression of heat or cold. For this reason, a bath at these temperatures is particularly suitable for cleansing purposes and also for underwater exercise. Their duration may be 15-30 minutes.
Hot Bath: An immersion bath with the water temperature ranging between 35C /96F and 40C/105F feels decidedly hot. At such temperatures loss of heat from the body's surface is stopped, except from the protruding head. At the same time, the body is heated by conduction and therefore the temperature of the entire body will rise. The immersion bath is a rapid means of producing artificial fever. Its efficiency is so great that it may prove a dangerous method for the maintenance of prolonged temperature elevation. Short periods of immersion may cause comparatively little dislocation of the temperature level. Baths lasting two to fifteen minutes are employed in the treatment of chronic rheumatic manifestations in joints, fibrous tissue and muscles; for the relief of muscle spasm, and of colic in the gastric, intestinal, gall bladder, or urinary tracts.
Excellent results are obtained by hot water baths in clients suffering from chronic arthritis. It is recommended that the client be placed in a tub with the water at about body temperature. After immersion the temperature is increased to the point at which it produces maximum muscle relaxation (about 38C /101F to 40C/104F); it is then gradually lowered to the level found most comfortable for the client (between 35C/96F and 36C/98F). Underwater massage should be applied while the client is in the tub; motion should also be encouraged; first passive, then active and later resistive. Because of its severity, this type of bath should not be administered to clients with diseases, such as those involving the heart and arteries or the central nervous system.
Cold Bath: A cold immersion bath whose temperature varies from 10C/50F to 21C/70F may be used, but for very short periods of time (four seconds to three minutes) during which the body should be briskly rubbed by the client himself or by an attendant. After the bath, the client should be briskly rubbed with a towel and dried quickly. Because of the vigorous reaction which it produces, this bath should be given only to robust individuals. In such persons, it causes a feeling of general exhilaration; the circulation becomes more rapid and the appetite is stimulated. If chills develop, the client should be promptly removed from the bath. The cold bath is used as a metabolic stimulant, for obesity, and for atonic states. It should not be administered to very young or very old persons.
Contrast Bath: One way to influence the peripheral circulation is by applying evocative stimuli to the skin. One of the simplest methods is by surrounding parts of the body with water at different temperatures.
A contrast bath consists of two water containers, each large enough to hold two legs. Into one container is poured enough cold water to cover the immersed leg, and the other container is filled with hot water. Since the total duration of treatment is relatively short, thermostatic control of the water temperature is not required. The cold water may be held at a level of about 10C/50F to 16C/61F and the hot water at 38C/100F to 44C/111F. The leg or legs are first placed in the hot water for four to six minutes and then at once in the cold water for one to two minutes. For the client to end treatment with a feeling of comfort, the final immersion should be in the hot water.
Contrast baths are used to stimulate local circulation in limbs without obstructive vascular pathology.
Natural and Artificial Baths; Carbon Dioxide Baths: The immersion bath can be modified by mixing various gases and solid substances with the water. Such mixtures sometimes occur naturally and furnish the raison d'etre for spas throughout the world. Waters containing large amounts of carbon dioxide are found in certain places; for instance, at Bad Nauheim (FRG) and Saratoga Springs (USA). Effervescing carbon dioxide baths may be made artificially by means of a special carbon dioxide mixing apparatus;
by permitting carbon dioxide gas to flow from a cylinder through perforated tubes placed in the bottom of the tub;
or by adding chemicals to the water. None of these baths is as effective therapeutically as
natural carbon dioxide water.
To make the third type of bath four to eight pounds of salt are placed in a tub containing about 40 gallons of water. One-half pound of sodium bicarbonate is added, then six to eight large tablets of acid sodium sulfate are placed at equal intervals at the bottom of the tub.
The special beneficial action of these baths is attributed to the bubbles of carbon dioxide gas which are liberated in great quantities. The client should lie quietly in the bath, without unnecessary motion, to avoid dissipating the layer of bubbles next to his skin.
Baths are administered every other day, with progressively increasing percentages of carbon dioxide. At the start, 25 percent is used; this is increased to 50, 75 and 100 percent. If dyspnea is relieved, the temperature of the baths is reduced to as low as 86F.
The number and frequency of baths are arranged in accordance with the results achieved. When the cardiac insufficiency is relatively recent or the compensation is good, full-strength saline and carbon dioxide baths are administered in a series of three. The temperature of the first bath is held at 35C/95F. Subsequent bath temperatures are reduced, 26C/80F being the lower limit. The duration of the bath is increased up to a period of 12 minutes. If there is no disturbance of compensation, the first bath may be a combination of carbon dioxide and saline in their strongest concentration, at a temperature of 32C/90F, for a period of 10 minutes. The time may be gradually extended up to 15 minutes.
In cases of high blood pressure, the temperature of the bath should not be reduced below 35C/95F. In "nervous or functional heart conditions", the baths are first administered for five minutes at 33C/93F; thereafter the temperature is reduced at each bath until a level of 29C/85F is reached. The time for taking these baths is in the morning, two hours after a light breakfast. It is important that they be followed by a rest period of two hours; otherwise, much of the benefit is lost.
The carbon dioxide in the bath enters the body through the skin. The skin becomes red, indicating increased circulation not resulting from temperature influence. Corresponding diminution takes place in the circulation of the deeper organs. The heart is slowed, possibly by reflex excitation of the vagus nerve. The carbon dioxide bath has an action similar to digitalis on the blood pressure; if high, the blood pressure is lowered; if low, it is raised. Respiratory and pulse rates are slowed. There is increased elimination of urine. The cardiac muscle becomes trained without increasing the frequency of the heart beat. Contraindication; heart disease with decompensation and marked arteriosclerosis.
Oxygen Bath: Oxygen may be introduced into the water of a bath from perforated tubes lying at the bottom of the tub and connected to an oxygen tub. In an oxygen bath the temperature of the water should be held between 32C/91F and 35C/95F. The duration of the bath should be 10-20 minutes. Its effect is soothing. Its use is in the treatment of hypertension, advanced cardiac disease, nervous irritability and insomnia.
Brine or Salt Bath: Brine waters occur naturally at certain spas. Artificial brine baths can be made by adding from five to eight pounds of sodium chloride to 40 gallons of water. The temperature of the water should be between 32C/90F and 40C/105F; the duration of the bath, 10-20 minutes. Where higher concentrations of salt are employed, the increased buoyancy may make it necessary to hold the client down with weights. Artificial sea water baths are made by mixing seven pounds of sodium chloride, one pound of magnesium chloride and one half pound of magnesium sulfate in 30 gallons of water. Indications for saline baths include osteomyelitis, fractures, dislocations, arthritis, myositis, fibrositis, gout, chronic sciatica, and obesity. Contraindications are arteriosclerosis, cardiac disease, hypertension, and inflammations of the skin.
In Part 3 Dr. Bergel's article will conclude with a discussion of Hydrotherapy Showers.
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