HYDKOTHERAPY. 386 HYDROTHORAX. tiiny be used cither internally or externally. In- ternally it may be used simply to wash out a cavity — the nose, the mouth, the stomach, the bladder, or the rectum. In addition, it may be taken internally hot or cold and passed into the blood. It may be used hot in the rectum, as a simple enema, or for purposes of stimulation. E.xternally, water may l)c used in many con- ceivable ways, but essentially the use of water means with it the use of two very necessary aids, heat and cold. Hydrotherapy, a|)art from the use of heat and cold, is of scx'oiidary importance. The action of water in the treatment of di.scase is therefore largely mechanical. The psychical side is not unimportant. It has been used by en- lightened physicians ever since the dawn of medi- cine, and its ed'ccts taught in all medical schools. Only the quack and the charlatan will claim that hydrolherapy is a cure-all. Eccentricities, like tlie Kneipp cure and others, are to lie avoided by the sensible. Water acts physically and me- ehanicjilly. It is capable of readily taking up heat and of giving it up ; it thus lends itself most readily to the use of thermal agents. It may lie used in gaseous form (steam), liquid form, or solid form (ice). The action of heat and cold is essentially important. Smooth muscVfibre expands under the action of moderate heat and contracts under the influence of cold. Its con- tracting power may be destroyed by an excess of either. Cold and heat, therefore, act as irritants to the nervous system, and tlirough their agency we can act upon all of the organs, to stimulate or depress their activities. The heart, lungs, kidneys, liver, spleen, skin, etc., may all be in- fluenced: the body heat and the output of mois- ture and secretions may be regulated. Thus by the use of heat or cold to certain portions of the skin or internally, almost every organ in the body can be inlluenced through its bloodvessels, and the skilled physician c.in. by guiding and directing these ell'ccts, bring about changes in vascular states; can remove excess of blood from one part of the body and bring it to an- other; can impart tone to a flagging organ, as the heart, or to the muscles or to the spinal cord; can increase the secretions from organs, such as the skin or the kidneys, and thus assist in excret- ing poisonous products from the body. The applications of water to disease are well systematized by Baruch as ablution, affusimi, sheet bath, drip sheet, compresses, wet pack, tub bath, and douche. Ablvtion. Simple application of water by the hand or moist cloth over the body. In fevers the abdomen, the back, the chest, the lower extremi- ties as far as the knees are bathed successively every two or three hours. A temperature of 7.1° F. should be used at first, and gradually re- duced to 00° F. Chilling is to be avoided. " Re- action is to be gained, the superficial capillaries becoming sufl'used and the body assuming a pinkish hue. Rubbing should always be used in ablutions. Affi-.sion. The patient, with a cold wet cloth about the head, sits or stands in a tub containing about a foot of water at 100° F. A broad stream of water from a bucket or pitcher is poured with force directly over the body. The stimulation .will dpf)end upon the temperature of the water and its force of deliver^'. This is often used in states of profound prostration, in coma, and in stuporous, delirious states. Sheet B.vth. A rubber sheet is laid down over one-half of the bed. This is covered by a blanket. Then a linen sheet is dipped in water at a tem- perature of from CO to 70° F., and while still wet is wrapped about the patient while he lies upon the blanket. The face is bathed in ice-water and the head covered with a wet towel. The nurse or attendant rulis the patient energetically over the body. As the body reacts and becomes warm, water at still lower temperatures may be sprayed over the sheet, .fterwards the ])atieiit may lie wrapped up in the blanket. This is an excellent method for reducing temperature in fevers, and is applicable in practically all acute diseases accompanied by liigh temiH-rature. Dbip Sheet. The patient, standing in a tub of water at 100° F., has a wet sheet, wrung out, wrapped about him. He is then firndy rubbed until a reaction occurs. He may be slapped gently instead of being rubbed. This procedure forn'.s an excellent tonic in nervous exhaustion, in the early stages of tuberculosis, and in chlo- rosis or anxmia. CoiirHEssEs. Tliese consist of bands or squares of old linen to which llannel is attached and strings made to fasten the appliance about a part. The linen piece is usually wrung out of hot or cold water and applied to the part and wrapped about by the flannel to prevent evapora- tion. These compresses are valuable in sore throat, tonsilitis, rheumatism, pneumonia, sprains, etc. They should be renewed hourly in acute processes. Wet Pack. This is similar to the sheet bath, save that the sheet covering the body is wrung dry and then the patient is rolled up completely in thick blankets. The air should be kept out by fixing the blanket very securely about the feet and neck. The wet pack is more useful in chronic cases. Friction is essential in the acute cases, in order to bring about quicker reaction; hence in these the sheet bath is usually preferred to the wet pack. Tub Bath. A trained nurse should give this bath. See Tvpnoin Fever. Douche. This apparatus throws a jet of water against the body from a hose, and is best given in .a sjwcial institution devised for this work. Arrangement is made in the apparatus whereby the force of the jet and its temperature can bo regulated. Consult Baruch, Principles and Practice of Ilfidrotherapy (New York, 1900). See Bath; Typhoii) Fkvek. HY'DROTHOTIAX (Neo-Lat., from Gk. Mu/7, 7ii/(fdr, water + 6upa^, thOrax, cheat) . The term applied to dropsical collections in the pleura (q.v.), a closed .serous sac enveloping the lung on either side. When it exists to any extent, the pressure which it exerts on the lungs impedes the passage of the blood through them, and oc- casions difficulty of breathing, lividity of counte- nance, etc., and more or less dropsy in the face, ankles, etc., soon appears. The physical signs by which the disease can be detected are changes in the condition of the chest, as ascertained by auscultation, percussion, and succussion by the physician. Hvdrothorax may depend upon inflammation of the secreting membrane, or it may be a conse- quence of organic disease of the heart or Ivmgs, liver, or kidneys. With regard to treatment, when the disease seems to depend upon inflammation
