ARMED FORCES MEDICAL LIBRARY Washington, D. C. AN INAUGURAL DISSERTATION ON THE WARM BATH: SUBMITTED TO THE EXAMINATION OF THE REV. JOHN EWING, S. S. T.P. PROVOST; THE TRUSTEES AND MEDICAL FACULTY OF THE UNIVERSITY OF PENNSYLVANIA, # i FOR THE DEGREE OF DOCTOR OF MEDICINE. ^ ON THE iS?#\ EIGHTH DAY OF JL a, IP >t,^ rf f/^ViA By HENRY WILSON LOCKETT& <~r-J* OF PRINCE EDWARD, VIRGINIA; ^^^i^.,^- Member of the Philadelphia Medical and Chemical Societies. PHILADELPHIA: PRINTED BY CARR &? SMITH, 1801. I TO OSBORN LOCKETTE, Esquire, OF VIRGINIA. SIR, I feel myfelf gratified in having an opportunity of thus publickly acknowledging the many obligations, by which I am connected with you, above thofe of fraternal affinity. * Vouchfafe Sir, to accept this as a fmall but unfeigned token of gratitude, for the many inconveniencies you have fubjected yourfelf to, for my accommodation, and the friendly exertions you have made for the accomplifhment of my education. That you may experience the bleffings of health and un- interrupted profperity is the cordial wilh of Your fincere friend, And affectionate brother, HENRY WILSON LOCKETTE. TO THE MEDICAL PROFESSORS IN THE UNIVERSITY OF PENNSYLVANIA. GENTLEMEN, Condescend to accept this as a fmall but fincere token of gratitude for the many improvements I have derived from each of your lectures.—You are all entitled to an equal lhare of my efteem and regard. That you may long enjoy health and thofe faculties for the inftru&ion of youth which you now fo eminently poffefs, is the cordial wifh of Your fincere friend And grateful pupil, HENRY WILSON LOCKETTE. AN INAUGURAL DISSERTATION, &c. AN Enquiry into the properties of the Warm Bath may be arranged under three heads— I. Its effecls on the human body in health. II. Its prophylactic properties. III. Its medical properties, or the falu- tary effects obtained from it when ufed in difeafes. For the accomplifhment of the firfl of thefe purpofes, I inflituted a feries of experiments which, if not executed with accuracy and judgment, will at leaf! be related with can- dour. Experiment 1. March 16, 1801. I breakfafled on bread and butter and coffee, about 8 o'clock. Three hours after, viz. about 11, having pre- C 2 ] pared a bath at 98° of Fan1, in a room the temperature of which was 67°, I went into it, my pulfe beating 80 flrokes in a minute. The following was the refult. Minutes. 1 | 3 | 5 | 7 | 9 | 11 | 13 | 15 | 1? | 19 | Pulfe beat. 86 | 75 | 83 | 78 | 79 | 85 | 82 | 79 | 80 | 70 | M. 21 | 23 | 25 | 27 | 29 | 31 | B. 76 J 75 | 82 | 80 | 78 | 74 | After drefling, my pulfe was examined again, and found to beat 77 flrokes in a mi- nute, at 12 o'clock 70, I did not examine it further. When I firfl went into the bath, it produced very pleafant fenfations, but after fome time a flufhing of the face, and a dull pain of the head with oppreffion about the region of the fcrobiculus cordis came on, and my refpiration was not as free as before im- merfion. In about 15 minutes after immer- fion, the water felt much cooler than at firfl, though the temperature did not vary more than two degrees during the whole of the experiment. Jufl before leaving the bath I was feized with flight cramps in both feet, and felt chilly on riling out of the water. Experiment 2. March 23d. I breakfafled as before. At half pafl 10 o'clock my pulfe was examined [ 3 ] when it beat 77 flrokes in a minute in a room the temperature of which was 64°. I then put my feet in water at the temperature of 110. Minutes. 3 | 8 | 13 | 18 | 22 | 27 | 32 Pulfe beat. 81 | 76 j 81 | 89 j 84 | 87 | 92 There was a very confiderable enlarge- ment of the veins in my feet and legs ; the rednefs on my legs was likewife confiderable. I felt a fmall pain in my head which left me after dreffing ; the temperature of the water had funk to 101° at the conclufion of the ex- periment. Experiment 3. On the fame day my friend Mr. Mitchell, a young man in perfecl health, of a robufl and athletic conflitution, having breakfafled flightly at 8 o'clock, immerfed himfelf at half after 11 o'clock in water heated to 107°, in a room at the temperature of 68°. His pulfe, which before entering beat 72 flrokes in a minute, Minutes. 1 | 3 [ 5 | 7 | 9 | 11 | 13 | 15 Pulfe beat. 105 | 108 j 115 | 110 | 119 | i05 | 115 | 114 He complained greatly and faid he could not bear it. It produced great rednefs of the fkin, flufhing of the face, and an inclination to fleep or drowfmefs, with fome difficulty of C * ] refpiration; after a while he fweated pro- fufely, which in fome meafure relieved his drowfmefs. I examined his pulfe again after dreffing, when it beat 105 flrokes in a minute, and in the courfe of a quarter of an hour it was reduced to 84. Experiment 4. March 24. The fame young gentleman having breakfafled as before, at the fame hour, entered a bath at the temperature of 96°, in a room at 66°, his pulfe beating 79 flrokes in a minute, Minutes. 2 | 5 | 10 Pulfe beat. 80 j 68 | 64 I then raifed the temperature to 100°, and in Minutes. 17 | 20 | 24 Pulfe beat. 82 | 79 j 80 I then increafed it to 105°, in Minutes. 30 j 34 | 39 Pulfe beat. 98 | 101 | 92 after which I did not raife it further. He began to fweat freely and yawned. I exa- mined his pulfe after dreffing, when it beat 77 flrokes in a minute. He complained of being debilitated, and particularly of a weak- nefs in the gaflrocnemii mufcles. [ 5 ] Experiment 5. My friend Mr. Mitchel was alfo the fub- je£l of the following experiment. Having breakfafled about 9 o'clock as ufual, he en- tered a bath at 90° Fan*, in a room at 60°, his pulfe beating 80 flrokes in a minute, In 3 | 5 b. 64 j £>4 I then raifed the water to 100°, when it beat In 10 | 13 | 15 B. 72 j 72 j 72, I afterwards increafed it to 105°, and his pulfe In 25 | 27 [ 30 | 35 | 37 is. 107 j 110 | 115 | 118 | 115 From the time the bath was increafed to the lafl mentioned degree of temperature, the fweat began to flow freely, and he had fome difficulty of breathing. On leaving the bath he faid his head ached confiderably. There was a great rednefs of the skin all over the body, and a flufhing of the face. After he had drefTed, his pulfe beat 80 flrokes in a mi- nute, and was fuller than before the com- mencement of the experiment. Experiment 6. March 20th. I breakfafled at half pafl eight o'clock on bread and butter with a fmall llice C * ] of cheefe and coffee. At half after eleven, a bath being prepared at 90° and my pulfe examined which beat 83 flrokes in a minute in a room at the temperature of 68°—I de- fcended into the bath and remained there 5 minutes, when my pulfe was again exami- ned by my friend Mr. Lee—it beat 79, and in 10 minutes 80°. The temperature was in- creafed to 98° and in five minutes my pulfe beat 80°, and in ten 77°. The temperature was then further increafed to 108° ; five mi- nutes after which my pulfe rofe to 119° and in ten to 130°. It was then increafed to 111° when in 3 minutes my pulfe rofe to 153°. The heat was now infupportable—It produced confufion of thought, partial delirium, tinni- tus aurium, an inability to fpeak, dimnefs of fight, an intolerable pain in my head with a moll painful defire to make water. My fen- fations were precifely fuch as they are in a violent flate of fever. There was a great rednefs of the fkin and flufhing of the face. On raifmg myfelf out of the water I almofl fwooned, and being now covered with blan- kets, fweated very profufely. In about a quarter of an hour as I am informed (for I was too much affected by the experiment to obferve it myfelf) a few ounces of blood were C 7 ] taken from my arm which exhibited the fol- lowing appearances: It was highly oxyge- nated and did not coagulate tho' there was on the top a thick tough inflamatory fcum of a fomewhat blueifh colour. Many fiery par- ticles fluck to the fides of the veffel. In fa£l it exhibited all the appearances of diflblved blood to thofe who faw it. Experiment 7. March 27. My friend Mr. Lee having exa- mined his pulfe which beat 60 flrokes a mi- nute, in a room at the temperature of 57°, put his feet and legs up to the garterings be- low the knees, in water at 98°. In 5 minutes it raifed his pulfe to 66 flrokes. I then in- creafed it to 105° and in 3 minutes his pulfe beat 74, in 6—72. I afterwards increafed it to 110°, in 3 minutes his pulfe beat 79, in 6— 90. He now began to fweat. On the addi- tion of 3 degrees more, his pulfe beat 101, in 6 minutes 105—and finally, on railing it to 115° his pulfe in 3 minutes beat 122, in 6— 130. It produced rednefs on his feet and legs and flufhing on the face, but no pain of the head. In about 5 minutes after leaving the bath he was bled. The blood feparated into crafTamentum and ferum, though there C [ 8 ] was not fo much of the latter as is commonly obferved. The ferum was coloured red by the red globules, and a fmall quantity of blue inflammatory crufl appeared on the furface. This commenced at half pail 11 o'clock, A. M. Experiment 8. March 30. I breakfafled on bread, butter, and coffee, about 8 o'clock. At half pafl 11 I prepared a bath at 98° Faht. and entered it, my pulfe beating 92 flrokes in a minute, in a room at the temperature of 6 5°. I endea- voured to keep the bath as near the fame temperature as poffible by repeatedly exa- mining and making additions of warm water. The refult was as follows. M. 5 10 | 15 20 25 30 35 40 45 50 | 55 60 B. 92 84 85 81 82 84 84 85 83 79 76 77 During the time I remained in the bath I felt a flight pain in the head, and a little flufh of the cheek. On coming out of the water, I was chilly, and my fkin every where exhibited what is termed the cutis anferina. Experiment 9. April lfl. Mr. Mitchell having break- fafled as ufual between 8 and 9 o'clock, at a [ 9 ] quarter after 10 entered a bath at 102° of Faht. his pulfe beating 80 flrokes in a minute. I endeavoured by repeated additions of warm water to keep the bath at the fame tempe- rature. M. 4 | 10 j 15 | 20 { 25 | 30 | 35 | 40 [ 45 1 50 | 55 | 60 P. 81 |~82T| 90 j 93 | 94 | 92 | 94 | 98 j 94 | 92 | 98 | 92 When he had remained in the bath a fhort time he began to fweat freely, and continued to do fo as long as he was in it. It pro- duced rednefs on the fkin, flufhing of the face, a flight pain of the head and a defire to make water. Experiment 10. To afcertain the comparative effecls of the warm bath in toto and ex parte, I inflituted the following experiment. The young gen- tleman who was the fubje6l of the one lafl related, having breakfafled as ufual, and all other circumflances being the fame, except that the temperature of the room was 2 deg. higher, and his pulfe 5 flrokes flower in a minute than yeflerday, put his feet and legs into water of the fame temperature up to the garterings below the knees. The refult was this. M- 5 | 10 | 15 [ 20 | 25 j 30 | 35 [ 40 | 45 | 50 | 55 | 60 B. 87 | 89 | 86 | 88 | 90 | 90 j 98 j 99 | 97 j 94 | 93 j 90 [ io ] It produced a gentle diaphorefis on the body and confiderable rednefs on the feet and legs. His pulfe was not fo full and round in this as in the former experiment, though it was quite foft. In this experiment we ob- ferve the pulfe to be raifed feveral flrokes higher in a minute—what can be the occafion of it? Profeflbr Rufh remarks that the fitua- tion of the body influences the frequency of the pulfe, now may we not conclude that this was the caufe of the difference here, fince he lay down in the former and fat up in the latter ? Experiment 11. April 4th. I breakfafled as ufual about 8 o'clock, and about 20 minutes after 10, en- tered a bath of the temperature of 95°, my pulfe beating 78 flrokes in a minute, in a room the temperature of which was 74°. As in the three preceding experiments, I endea- voured to keep the water at the fame tempe- rature. M. 2 | 5 | 10 | 15 | 20 | 25 | 30 | 35 [ 40 | 45 ) 50(55160 B. 83 | 81 | 79 j 76 j 75 | 71 | 73 | 72 j 72 | 71 | 75\75\75 It produced no flufhing of the face nor red- nefs of the fkin. At firfl it felt agreeable, but after fome time rather cool. On leaving C 11 ] the bath I experienced a chilly fenfation, and my fkin exhibited the cutis anferina. In a quarter of an hour my pulfe was examined when it beat only 68 flrokes in a minute. I experienced a confiderable degree of laffitude with an inclination to fleep, until I had dined, when I felt as ufual. Experiment 12. Having breakfafled about eight o'clock as ufual, at 10 I went into a bath at 92°, my pulfe beating eighty-four flrokes in a minute and the temperature of the room 70° of Fan*. Minutes. 5 | 10 | 15 | 20 | 25 | 30 Pulfe beat. 77 \ 75 | 74 | 72 | 73 | 76 After leaving the bath I felt fomewhat de- bilitated and was flightly affected with fpafmo- dic contractions of the mufcles (commonly denominated cramp) particularly in the thighs. From all the experiments that have been related I deduce the following inferences. lft. That any temperature below 98° of Fan*, which does not produce the fenfations of cold ought to be termed the tipid bath be- caufe it rarely or never increafes the frequen- cy of the pulfe and when it does it fpeedily reduces it below the natural flandard again. Moreover I have never obferved it to produce fw eating. [ 12 ] 2d. From 98° to 105°,we fhould denominate the warm, becaufe, it accelerates the pulfe, induces very free perfpiration, and does not produce any diflreffing fymptoms. 3d. From 105, upward we may defignate by the epithet hot bath—I likewife conclude that the warm bath is a powerful ftimulant and fhould never be advifed or prac"lifed in inflammatory difeafes or ftates of fever of violently morbid a£lion. That the warm bath fo far from pofTeffing any relaxing property which has been afcri- bed to it; may with propriety be confidered as a moll valuable tonic. That it does not debi- litate fo much as the tipid bath—and that it relieves fpafms, convulfionsandftri£lures, not by relaxing them but by removing the exift- ing debility and flimulating the parts affe£led to perform their due functions, I infer from obferving that the lower the degree of tempera- ture in what I have called the tipid bath the greater the debility ; and I have not obferved any confiderable degree of debility produced by it until it was increafed beyond the degree to which I have limited the warm bath when indirecl debility was induced from excefs of flimulus ; and that the tipid bath fhould not be ufed in chronic ftates of fever and debilita- C 13 ] ted habits is as obvious as that the warm bath fhould not be recommended in difeafes of vi- olently morbid excitement. That it is unpar- donable to ufe the hot bath without the ut- rnoft caution and the patient fhould never be immerfed in it at firfl; but fhould be put in the warm bath and the temperature increafed gradually until it is raifed as high as is necef- fary. If the hot bath has fuch an influence on the pulfe in health, how abfurd and inju- rious muft it be to direct it in inflammatory difeafes ; a thing too often done by phyficians. It is impoffible to recount the evils that may refult from fo prepofterous a practice; even the Warm Bath muft prove (fimilar to all other powerful remedies) very deflru&ive in the hands of ignorant perfons. The hints and cautions that will be fug- gefted in the fequel of this differtation, con- cerning the ufe of the Warm Bath will fuper- cede the neceffity of expatiating more largely in this place as they will come in much better in their proper places. Experiments with the Steam Bath. Having breakfafled as ufual, at 10 o'clock, my pulfe after undreffing beating eighty flrokes a minute and the temperature of the C 14 ] room 70° of Fan*. I fhut myfelf up in a machine made for the purpofe of containing vapor, into which the fleam was conducted by means of a tea-kettle and tube : the following was the refult. rees of Therm. Minutes. Pulfations. 85 5 87 95 10 84 96 15 84 95 20 81 95 25 81 100 30 98 106 35 109 began tofweat 104 40 106 108 45 105 110 50 124 107 55 118 111 60 130 It produced fullnefs of the head but no pain, refpiration was accelerated and fome- what difficult though not diftreffing, very great rednefs of the fkin and flufhing of the face. In 5 minutes after leaving the bath my pulfe was examined and found to beat 88 ftrones in a minute. I had a great inclina- tion to fleep about an hour after, which I in- dulged for fome minutes when it went off. Experiment 2. Having dined between 2 and 3 o'clock, P. M. at 6 I went into the machine above- mentioned. The fleam was now thrown in [ 15 ] fuch quantity that it raifed the temperature from 70° to 100° in a few minutes. My pulfe beat 80 at the commencement of the experi- ment. Degrees. Minutes. Pulfations 100 10 86 107 15 89 107 20 92 108 25 95 112 30 111 120 35 132 It produced a copious flow of fweat, great rednefs of the fkin, flufhing of the face; but no pain of the head. I experienced none of thofe diftreffing fymptoms which were felt when I entered water at a much lower tempe- rature. I felt a little fick after leaving the bath, which immediately left me upon put- ting myfelf into a recumbent pofture. Experiment 3. April 30. Having breakfafled as ufual, at forty minutes paft 9 o'clock I entered the machine, and threw into it the vapours of brandy, but by fome accident the fpirits caught on fire, and the experiment did not fucceed as well as I could have wifhed. I will neverthelefs relate the refult, and let every perfon judge for himfelf. My pulfe D C 16 ] beat 87 flrokes in a minute, in a room at 70 deg. of Fan*. egrees. Minutes. Pulfations 87 5 94 90 10 94 98 15 95 97 20 95 94 25 92 It produced fome rednefs on the fkin, a very gentle diaphorefis, no pain in the head or other difagreeable fymptoms. By collat- ing this with the former experiment, we will plainly perceive that a lower degree of this raifed the pulfe, than of the former; but whether it effected this by its flimulating pro- perty on the external furface may be quef- tioned as there was a confiderable inhalation of the vapours by the lungs. I am induced to believe the former opinion, from the fuc- ceeding experiment with vinegar. Experiment 4. The following experiment was performed on the 1ft day of May at half paft 10 o'clock. I went into the machine into which vapours of vinegar were thrown, until it raifed the temperature to 95°, the temperature of the room was 70°, and my pulfe beat 84. C 17 ] Degrees. Minutes. Pulfations. 95 5 89 100 10 90 103 15 90 104 20 90 110 25 108 112 30 120 112 35 120 It produced the ufual effe£ts of the warm bath, fuch as rednefs of the fkin, flufhing of the face, profufe fweats, &c. I felt no pain in my head during my flay in the bath, but in about 15 minutes after coming out, I was very much troubled with it and ficknefs at my flomach, and was much debilitated during the whole day. After dinner I had fome fe- ver which went off in the evening. Experiment 5. I again attempted to procure a bath of the vapours of brandy, by fubftituting an EOli- pile in the place of the tea-kettle; my pulfe beat 75 flrokes in a minute, in a room of the temperature of 67°. The experiment com- menced at 45 minutes after 10 o'clock. Degrees. Minutes. Pulfations. 80 5 80 weak. 84 10 80 very weak. 84 15 80 do. 85 20 85 do. 87 25 80 do. 90 30 84 fuller. 92 35 86 [ 18 ] It produced neither pain in the head, dia- phorefis, nor flufhing of the face. From thefe few experiments with the fleam bath I am induced to prefer it to the water bath, becaufe, we can apply a greater degree (if neceflary) of heat, than we can in the wa- ter bath without diftreffing the patient fo ex- quifitely. This will caufe a more confide- rable flow of fweat, which is a very defirable object in fome inftances.* The difference be- tween water and brandy is not fo great as fhould prevail on any one to run the rifk of its conflagration. The vinegar may in my opinion be ufed with manifeft benefit in fome cafes, as in fcurvy and inveterate cafes of cu- taneous difeafes. It would give me great fa- tisfa6lion to profecute thefe experiments far- ther were I not prevented by indifpofition, having experienced a confiderable diminution of health for fome weeks paft, and probably in confequence of the above experiments. II. OF THE PROPHYLACTIC PROPERTIES OF THE WARM BATH. The politicians of all nations have efteem- ed it a greater mark of wifdom to prevent than to remove an evil. This maxim holds equal- ly good with phyficians, for in my opinion it requires more judgment and knowledge to obviate the predifpofition, than to cure a dif- eafe after it is completely formed. In the former inftance more fimple and mild medi- cines will anfwer the purpofe, but they muft be applied with greater nicety. In the latter cafe more powerful remedies and greater re- folution in the phyfician, are neceffary. As there is not a more fimple application than the warm bath in fome fhape or other, fo I believe there is none more efficacious ; yet if proper precautions be not taken, it may be productive of much injury. The cuftom of ufing the warm pediluvium indifcriminately, promifes on the whole to do but little good. It is highly neceffary to be enquired into and determined, at what time and under what cir- cumftances,it may be recommended with pro- priety and the greateft profpect of fuccefs. [ 20 ] It is of the utmoft importance to pay due re- gard to the condition of the fyftem in all our prefcriptions, and in none more fo than in our recommendations of the warm bath. The warm bath may be applied to the feet, or the whole body, in the debility which more or lefs precedes every flate of fever, when it acts like a charm by gently flimulating the fyf- tem to take on its healthy action, and there- by prevent the formation of a difeafe; where- as a more powerful flimulus being appli- ed might deftroy that juft equilibrium which is fo neceffary to health, or the ab- straction of a natural flimulus might pro- duce the fame effect.---If the phyfician could be called at the time when there only exifted that flate of the fyftem which is deno- minated predisposing, all that would be requi- site to be done, would be to bathe the patient's feet in warm water. On the contrary if we wait till the acceffion of the fever, we not only do not relieve the patient, but increafe all his fymptoms, producing delirium, great anx- iety, difficult refpiration, and in fome cafes even death. By this early application of the warm pediluvium, much time and expence might be faved to the patient, and the phyfi- cian relieved of no little of his anxiety of mind. [ 2! ] The practice of bathing the feet in warm water, under the idea of revulfion fo famous among the humoral pathologifls, has done more mifchief than it has done good : and has deftroyed numbers who might have been re- flored to health by remedies more adapted to the condition of the fyftem. When we de- termine to ufe the warm bath, the patient's feet and legs fhould be put in up to the gar- terings below the knees, and kept there for the fpace of an hour at leaft. If the whole body be immerfed in water, a lefs time will anfwer, obferving to preferve the water near- ly at the fame temperature or increafe it a little, for in an hour the heat will be diminifh- ed very considerably, and the latter part will be more like the cold than the warm bath. For this reafon it will be neceffary to make frequent additions. If thefe directions be attended to, the warm bath will be of ma- nifeft advantage, but if they be overlooked, it will (fimilar to other remedies) prove injuri- nous or even deftructive to the patient. In contemplating the many advantages which are to be derived from the early application of the moll fimple remedies, and how much la- bour and pain might be prevented thereby, C 22 ] we are aftonifhed to find fo much written about the cure, and fo little on the prevention of difeafes. Can this be owing to the intereft- edviews of phyficians, or is it rather to be at- tributed to the neglect of patients, in not fend- ing for aid until the fortunate moment is pars- ed ? That the latter is the true caufe will be acknowledged by every ingenuous and un- prejudiced mind. The warm bath has been recommended and practiced to obviate the debilitating effects of hot climates. Mr. Bruce fays, that during his refidence at Maffuah, he derived very evident relief from it. The only benefit in my opinion that can be obtained from its application to the body in thofe climates is to preferve the fkin clean, and thereby pro- mote a free perfpiration. For if the heat is already fo violent as to induce indirect dibili- ty, the hot bath inftead of relieving the fyf- tem, will tend very much to deprefs it below the point of reaction. Now I fhould rather fuppofe the cold, or even the tepid bath would be of more fervice and promife much fairer to exonerate the fyftem. The tepid bath not only promotes perfpiration but alfo increafes evaporation. However, as all theory muft / C 23 ] yield to the teflimony of experience, I am compelled to relinquish my theoretical fpecu- lations upon the authority of fo great a man as the one quoted above to whom many others equally refpectable might be added. We can, however, better explain the ope- ration of the warm bath in old age, when it acts like a frefh fupply of oxygene to a glim- mering taper. The agreeable impreffion it produces may fupply the place of many of the natural flimuli, that by frequency of repe- tition have become incapable of exciting the fyftem to the performance of its various func- tions. Doctor Franklin received great bene- fit from it. It prevented the too fpeedy ap- proach of old age, and enabled him to fup- port the infirmities of his lafl days with lefs perceptible decay. It muft be continued re- gularly, and for a long time in this period of life to obtain its salutary effects. The de- gree of temperature fhould never be below 100° of Fahrenheit's fcale and as much higher as is agreeable to the fenfations of the patient. The warm bath is found to be of eminent fervice in removing the conftriction induced on the blood-veffels by the debilitating paffion of fear, which takes place frequently in bleed- ^ ing, for we often fee that the blood will hot E C 24 ] run until the patient's feet or hands are put into warm water, when the blood begins to flow, after the fpafm of the veffels is removed by the flimulus of heat. The warm bath may be ufed as a preven- tive of all thofe difeafes which fo frequently originate in crowded hofpitals, jails, &c. In this inftance it acts in two ways ; lft. by pro- moting perfpiration which is fo neceffary for the prefervation of health, that, whenever we difcover any obftruction in the cuticular exha- lants, we are certain the foundation of fome difeafe is laid. 2dly, It may fupply the place of fome other ftimuli, as frefh air, or exercife. It is practifed by the ladies of fome nations in the latter period of pregnancy, to render their labours more eafy and expeditious. The warm bath is employed by the ^Egyptian ladies, efpecially the Hebrew women, to ren- der them more corpulent. In what manner it operates to produce this effect is fome what difficult to explain. III. OF THE MEDICAL PROPERTIES OF THE WARM BATH. Moft phyficians have a predilection for fome particular medicine, which, they ufe on all occasions, without confulting the condi- tion of the patient's fyftem, but it comports more with the dignity of the profeffion, and the improving flate of fcience, to rely on no one remedy to the exclusion of all the reft, when the fafety of the patient calls for all the relief that can be afforded by our art. It has been too much the cuftom among thofe who recommend particular medicines, to relate i only the fuccefs, and not the difadvantages which attend their exhibition, which leads to their ufe in all cafes. If they do not fucceed at once they either are neglected altogether, or not continued long enough to produce the defired effect. The warm bath has been recommended in a variety of difeafes, and I have no doubt a- dopted with advantage in many; yet, I be- lieve it has been ufed with evident detriment to the patient, and fometimes even with fatal confequences, all originating from inattention [ 26 ] to the directions given in a former part of this EfTay, and which have been too much ne- glected by practitioners in all ages. To give a minute hiftory of the warm bath from its origin—to enter into a particular detail of all the difeafes in which it has been praetifed with benefit, would enlarge this dif- fertation to a fize far beyond the limits to be prefcribed to Effays of this kind. I muft, therefore, content myfelf barely to mention that it is of high antiquity, having been ufed both by the Greeks and Romans as a remedy for certain difeafes, and alfo as a luxury. The excefs to which it was carried by the latter nation as a luxury, maybe learned from the moralifts of that once great and flourifhing empire. Of the benefits obtained from it in difeafes, I fhall now treat more largely—a part of my differtation for which I am forced to acknowledge my obligations to others. The warm bath promife s to be of fervice in all ftates of fever, of feebly morbid action, or which are denominated atonic difeafes. Mania.—This difeafe has been ranked among the opprobria medicorum by the illi- terate and unthinking part of mankind in all ages ; nay, it has even been acknowledged as C 27 ] incurable by fome of the faculty, who have trodden in the footfteps of their predeceffors and who have not dared to think for them- felves. But fince phyficians, however, have thrown off thofe shackles, and obferved the operations of nature, it is become, (provided it be taken in time,) as manageable as in any other difeafes. When fuffered to run into that ftage, which I intend to mention particu- larly, it is found to be more difficult to re- move ; yet even here, the warm bath has been ufed with fuccefs, if not to the entire cure of the patient at leaft to his manifeft relief, which is a very important confideration. To obtain the beneficial effects of this remedy, we muft employ it for fome length of time and each particular bathing fhould be continued longer than ufual. Dr. Rush fuppofes three or four hours every day. In the atonic flate of mania when the violent action of the veffels has cea- fed, the diforder remains from a deficiency of motion in the brain, which cannot be remo- ved by any remedy more readily, than the one under confideration ; which can be regu- lated and adapted fo exactly to the flate of the fyftem. I should fuppofe, the warm bath might be practifed with advantage after the morbid action in the tonic flate of mania has C 28 ] been fufficiently reduced, as a preventive againft relapfes; for as I conceive there muft be an accumulation of excitability, of courfe the fyftem will be more liable to be thrown into morbid action on the application of any powerful ftimulus either to the mind or body. Whereas by the gentle ftimulus of the warm bath that equilibrium between the excitability and excitement which is fo requi- site for health may be obtained. But Dr. Pagiter is of opinion that it may be ufed in any flage of the difeafe. " The pedi and ma- nuluvia" fays he " upon the principle of re- " vulfion may have their good effects, and " may with fafety be ufed morning and even- " ing or oftener in every fpecies of infanity " and in every temperament of the conftitu- " tion whether fanguine or melancholic." I am really forry to find fuch a fentence in an author who wrote in the clofe of the 18 th cen- tury. The Doctor appears to be a man of more reading and fcholaftic learning than of judgment and refle&ion. To corroborate this opinion he in the next fentence tells us " I have more than once or twice known this " practice in low nervous fevers accompanied " with obftinate watchfulnefs, and hot dry " fkin bring on fleep, a fine moifture on the C 29 ] " furface of the whole body, which proved cri- tical." This I will grant the Doctor, but at the fame time, I will not admit that it is any proof of the propriety of using it in tonic mania, for it is now well known that in the tonic ftate of this difeafe, the brain and blood-veffels are too highly excited, and it is afcertained by actual experiment that the moll ready means to obtain a cure is by repeated and copious evacuations, or what I would call fedative re- medies. On the contrary we apply the moft powerful and durable flimulants to effect a cure of the low nervous fevers of which the Doctor fpeaks. Melancholy is another ftate of mania in which the warm bath joined with other re- medies has been practiced with great fuccefs. Hypochondriasis.—This difeafe, which is diftreffing to the patient and perplexing to the phyfician, is frequently removed by the warm bath after all other remedies have been tried to no effect. It is more particularly ferviceable in thofe perfons who are of a me- lancholic temperament. In thofe who are of a fanguine temperament it proves much more efficacious when preceded by gentle evacu- ations. It is found of eminent advantage in thofe hypochondriacal complaints attended [ 30 ] with convulsive fymptoms which proceed from repelled eruptions. It would be equally tedious and unnecef- fary to mention all the cafes of the falutary effe&s obtained from this remedy in thefe forms of difeafes, but there is one related by Dr. Percival, fo illuftrative of it, that I hope it will not be thought foreign to my purpofe to lay before the reader fome of the particu- lars. The patient was a clergyman, who faid his eyes felt as though they were drawn from their fockets, a conftant motion in his head from before upwards, and about his temples like the undulations of waves. The extreme fenfibility of his head would not permit him to wear a hat, but all this fays the D octor is trifling in degree when compared to the diftrefs of his mind. This gentleman, the Doctor informs us had confulted feveral phyficians of great emi- nence and tried a variety of remedies in vain. At firfl he derived fome advantage from the warm pediluvium and opium, of which he took 10 or 12 grains a day. But his relief from this fource was only temporary. When he reforted to the ufe of the warm bath, he obtained a fpeedy and lasting recovery. This is the moll diftreffing instance of the complaint I ever read of, and manifestly demonftrates [ 31 ] the happy confequences that may enfue from the ufe of the warm bath when skilfully ap- plied. Hysteria,has been fuppofedby many au- thors to be peculiar to the female fex, which the name does really imply, but I think I can add my teftimony to that of Dr. Cullen, who fays, " and indeed they (hyfterical fits) " moft commonly appear in females ; but " they fometimes, though rarely, attack alfo " males, never however that I have obferved, " in the fame exquisite degree." As to the propriety of the latter part of this fentence I am not fo confident, for the moft violent cafe I ever faw was in a man, though as I have feen but little of the complaint I cannot take upon myfelf to diffent from fuch autho- rity as Cullen. The warm bath has been very much extolled in hyfterical paroxyfms, but when they attack, as the above quoted author fpecifies, " females of the moft exqui- " fitely fanguine and plethoric habits, and " frequently affect thofe of the moft robuft w and mafculine conftitutions" I am of opi- nion the warm bath muft prove manifeftly detrimental. However when it attacks ladies of weak and delicate habit, it may be ufed with advantage as an auxiliary, and even in F c 32 n the other inftances after the plethora is re- duced, and the too great vibratility of the fyftem remains. I make no hefitation in recommending the warm bath in this difeafe when due attention is paid to the condition of the fyftem, without which precaution any medicine muft be pref- cribed with fome uncertainty. The warm bath will constantly tend to take off the too great vibratility of the fyftem, which is undoubtedly the principal caufe of this difeafe, and it may be ufed in many ha- bits as a prophylaxis—being careful that it be not too hot, which would probably in- duce the paroxyfms—a caution that ought to be obferved in all cafes. Tetanus-—This difeafe is alarming not only to the patient, but to the phyfician alfo, for one medicine will fcarce ever affect a cure twice in the fame hands fucceffively. It is therefore requifite that the phyfician be well provided with remedies, and as no article ranks higher in the lift of antifpafmodics (if there be fuch remedies) than the warm bath, fo I think there is none which promifes fairer to give relief than this. We have even in- ftances on record of tetansis being cured by it, conjoined with fmall quantities of lauda- C 33 ] num and antimonial wine, in which cafe wfl may conclude that the warm bath effected the greater fervice, for we know that fmall quan- tities of laudanum will produce no change in the difeafe, and as for antimonial wine we can expect very little from it. Some authors have recommended the fe- micupium, others warm fomentations in prefer- ence to the warm bath—" for, fays Dr. Hil- lary, I have more than once feen the patient " expire after being taken out of the bath, " though it was not too warm, being only " about 95° of Fahrenheit's fcale, and they " faid he had not been in the bath more than " 20 minutes." Indeed I fhould not expect much benefit from a bath of this temperature, becaufe from the eleventh experiment it ap- pears that its ftimulus is too feeble to effect any confiderable change when the moft pow- erful ftimulants are required, and its fedative qualities are not great enough to obtain any relaxation of the fpafms. Of courfe we ought not to expect the good effects of either the hot or cold bath from one of this degree of temperature. Upon the whole, I believe the hot bath may be ufed with fewer restrictions in tetanus, than almoft any other difeafe to which the human body is fubject. C 34 ] EriLEPSY.—Of this difeafe I fhall fay but little, becaufe fo little is known. There is fcarce a medicine of any confiderable efficacy in the materia medica but what has been ufed in it. A cure has been fometimes effected, but it more frequently baffles the fkill of the moft eminent of the faculty united with the moft potent remedies. Stimulants are recom- mended after the plethora of the fyftem is re- duced, on which it is frequently faid to de- pend, and as there is not a more univerfal or powerful flimulant than the hot bath, I con- clude it is as likely to effect a cure as any other medicine of that clafs. But I believe the cold bath has been found of more fervice in this difeafe than the hot, and in my opi- nion bids much fairer to perform a cure when the difeafe depends on a plethora. Syncope, when it depends on mal-confor- mation of the heart or large blood veffels, is generally looked upon as incurable, but when it depends on any other caufe it may be re- medied either by internal or external appli- cations. Of the latter kind none have been found of more fervice than the warm bath, if it be an habitual fainting, not depending on the above mentioned caufe. The bath muft be employed for a long time, and with great C 35 ] caution, for when too hot it will induce faint- ing. In fudden paroxyfms of fyncope I pre- fer the pediluvium to immerfion—and in this cafe I would recommend the water to be be- tween 105° and 110° of Fats*, becaufe below that degree the ftimulus is not powerful enough to excite the fyftem to action until the excitability is exhaufted. Typhus.—Under this title I comprehend all thofe ftates of fever which originate from filth in confined and crowded places fuch as goals, fhips, hofpitals, &c. and fuch alfo as proceed from ill-treated acute difeafes. In thefe ftates of fever the warm bath has juftly * acquired the highest encomiums, both from ancient and modern writers ; but fome among the moderns have fubftituted the cold bath in its place, and, as they inform us, with great fuccefs. How two fuch oppofite caufes fhould produce the fame falutary effects may appear fomewhat incredible at first view. The warm bath relieves the troublefome fymptoms of delirium, watchfulnefs, dry and parched fkin, which fo frequently attend thefe ftates of fever in a very extraordina- ry manner It promotes perfpiration, where- by the heat of the body is very much di- minilhed. Some have preferred the tepid C 36 ] affusion to immerfion, but I fhould fup- pofe the effects obtained by the latter to be more permanent. Dr. Brandris has furnish- ed feveral cafes wherein the moft happy con- fequences refulted to the patient from it, but the Doctor unfortunately does not inform us of the precife temperature of the bath. Were I to judge of the degree that ought to be ufed from the experiments on the body in health, which have been related, I would recommed at leaft 100° of Fah". and as much higher as may be agreeable ; to be continued not lefs than twenty minutes or half an hour. This remedy is rarely ufed in common practice on account of the inconvenience and difficulty of procuring proper veffels; but when we cannot practife immerfion, I would advife af- fusion, becaufe I am fo thoroughly convinced of the propriety of it, that, I think it fhould not be omitted on any occasion*. Paralysis—Is a difeafe of very ferious confequence, for it fometimes deprives the patient of all the enjoyment of his family, fociety, and even life itfelf, though he may furvive the attack many years. It frequent- ly proves the more diftreffing not only by de- priving the patient of the ufe of a limb or of the whole of one fide, but often injures the [ 37 ] fenfes and not unfrequently deprives the per- fon of the power of fpeech. Various have been the remedies recommended in this dif- eafe, and none with greater fuccefs (when di- rected with fkill and proper attention to the ftate of the fyftem) than the warm bath. This difeafe often attacks perfons of a phlethoric habit in which I fhould efteem the warm bath not only of no fervice, but highly injurious to the patient without previous eva- cuations. Under fimilar circumstances every kind of flimulating application muft prove equally detrimental with the warm bath. A decoction of fulphate of alumine and pure lime in rain water has been recommend- ed as highly beneficial in paralytic cafes, but with what profpect of fuccefs, more than we may reafonably expect from fimple water, I am unable to difcover. For the fulphuric acid poffeffing a greater affinity for lime than for alumine, will unite with it and form a very fparingly foluble compound, whilst the alumine remains behind, which I believe ex- erts very feeble powers in a pure and uncom- bined ftate. Baths impregnated with a vari- ety of fubftances have been mentioned as fer- viceable, but whether any of them have pro- duced effects that could not be obtained from C 38 ] fimple water, yet remains to be determined by experiment, the only certain guide to knowledge. The Sick Head-Ache, or nervous head- ache, has been very little attended to by phy- ficians. Dr. Fothergill is the firfl who has faid any thing about it: Dr.Dwight has fince written a differtation on it: and Dr.Rufh deli- livers fome very judicious obfervations on it in his courfe of lectures. I have feen the difeafe frequently, but never knew a radical cure performed by any remedy. The parox- fyfms are often relieved by the warm bath in the form of pediluvium. Dr. Dwight propo- fes to cure it by drinking a large draught of good cider in the morning before breakfaft; which, if the Doctor's theory of the difeafe be juft, promifes fairly to cure or rather to prevent it. This joined with regularity of life and the cold bath, is the Doctor's chief dependence, and has effected a cure more than once. As the difeafe is very diftreffing and the remedy fimple, it certainly is worth trying. Fothergill advifes great abftinence joined with regularity of life, and very particularly cautions perfons fubject to it againft dining on a variety of difhes at the fame meal. Dr. [ 39 ] Rufh thinks there is fome moifbid action al- ways prefent in the arterial fyftem, which muft be reduced by proper evacuations, pre- vious to the ufe of the warm bath, which he prefers in the form of fleam. He mentions a cafe wherein immediate relief was experi- enced by throwing a blanket all over a per- fon affected with it, then introducing a hot brick, on which vinegar was poured until the patient was bedewed with vapours. He like- wife advifes warm fomentations to the head, in any form that may be moft convenient to to the patient or attendants. The warm bath has been practifed with great fuccefs in all the difeafes of the intef- tines. Almoft every author who has writ- ten on the difeafes of the bowels has men- tioned it in the moft extravagant terms of pa- negyric : In all the different kinds of cholic it is particularly recommended ; and there is fcarce any fuch a thing as obtaining a cure of the colica pictonum without it, though this will not effect a cure by itfelf. In violent and obftinate conftipations of the bowels, it is a fovereign remedy. In long protracted dyfenteries, wherein the patient has become very much emaciated, it reftores not only the proper tone to the inteftines, but removes the [ 40 ] great degree of debility which is fo diftreffing to the patient, and fo frequently troublefome to the phyfician. I have feen it produce the moft happy iffue, in obftinate conftipations, after purges had failed. In hernise, where the intestines is confined by a ftricture, the bath has been practifed with manifeft benefit. How it produces this effect is a queftion of importance to be determined. A proper fo- lution of this query, might tend to introduce it into more general ufe. That the warm bath does really poffefs a relaxing property, I am in very great doubt, and I am happy to find myfelf fupported in this opinion, by fo refpectable authority as Dr. Darwin, who fays, " The unmeaning " application of the words relaxation and " bracing to warm and cold bath, has much " prevented the ufe of this grateful ftimulus." Yet it really does appear to relax thofe ftric- ture s : that it does remove them is fuffi- cient for my prefent purpofe, as the queftion has been already difcuffed in another part of this Effay. It may not be improper, in this place, to give a caution about the ufe of the warm bath in the difeafe mentioned above under this title, before fufficient evacuations have been ufed. C 41 ] The Gout which is fo conftant an attendant on the luxurious, and fo frequent a visitant of the devotees of Bacchanalian potation, and which fo feldom obtains admittance into the habitations of industry and temperance, is of two kinds, or rather has two ftages very dif- ferent from each other, and requiring dia- metrically opposite remedies. This and the following difeafe have been fuppofed to be the fame, differing only in degree, by a phy- fician, who is one of the brighteft luminaries of his country, who merits the highefl honors among the fons of iEfculapius, and for whom I cannot teftify my efteem in terms adequate to his worth: but yet candor and a love of truth obliges me to diffent from his opinion, in this particular inftance, as I have obferved the former to attack the luxurious and intem- perate only; the latter, to invade equally the king in his palace and the peafant in his cot- tage, when expofed to the caufes which in- duce it. The warm bath will be no lefs detrimental in the firfl than it will be ferviceable in the lafl, or what is called the atonic flage of the gout. When that period of the difeafe arrives in which it is proper to apply ftimulants, none can be recommended with greater profpect of [ 42 ] fuccefs that the warm bath from its power- ful and univerfal operation. It is not only found beneficial in relieving the patient's fymptoms, but it is an excellent reftorative to thofe habits which have been debilitated by repeated and fevere attacks. It is like- wife recommended as a very valuable pre- ventive in thofe who are fubject to frequent returns of the atonic ftate. " Where the patient is too weak to be taken out of bed and put in a bathing tub his limbs and body fhould be wrapped in flannels dipped in warm water" the temperature whereof fhould never be below 100° of Fahrenheit's ther- mometer and as much higher as may be agree- able to the patient's fenfations. The Rheumatism attacks chiefly the la- bouring part of mankind and thofe in particu- lar who are expofed to cold and moisture, and viciflitudes of heat and cold, though none are exempt from it when expofed to its caufes, as I have noticed. This difeafe has two ftates ; in one of which the warm bath muft be manifeftly prejudicial, and in the other as evidently beneficial. In long protracted cafes where fufficient evacuations have not been made in the inflammatory ftage and in old worn out conftitutions, it has been ufed with C 43 ] great fuccefs, but in robuft and phlethoric perfons from its increafing the morbid action of the blood-veffels it proves a very inadvife- able remedy without previous evacuations. Warm fermentations and rubbing the part affected with volatile and faponacious lini- ments have been recommended by Dr. Mon- ro ; but the fuperior efficacy of the warm bath over all other remedies, appears from the many cafes recordedby Dr. Fowler, who fays, " The fuperior efficacy of which in the pre- " fent cafe was unequivocal becaufe the fame " fudorific regimen was employed with each of the three remedies" (meaning the tincture of guaiacum, Dover's powder and the warm bath). The Doctor appears to think the fleam even more powerful than the water bath. After relating a cafe in which bleed- ing, bliftering and feveral kinds of diaphore- tic medicines had been employed, he fays " This affords a ftriking proof of the efficacy " of warm bathing, when feveral of the moft " powerful remedies had been adminiftered " with little or no benefit." This mode of commending the efficacy of certain remedies is very common among phyficians. It unfor- tunately leads to a belief that the one has been effected by a single remedy, when the [ 44 ] fuccefs of that remedy, has probably depended upon the difeafe having been weakened more or lefs, by all the remedies that had been pre- viously ufed. For further information on the fubject I muft refer to the author's book which contains a great deal of valuable in- flruction,- and many judicioufly practical ob- fervations. Scurvy.—I do not find any author who particularly advifes the common warm bath in this difeafe, that is, the difeafe to which feamen are fo much fubject. The natural warm baths have been ufed with manifeft ad- vantage. Lind fays he has recommended the feet and legs to be bathed in warm vinegar, and it was practiced with evidently good effect. Dr. Blane informs us, " Dover's powder " and camphor given as fudorifics have pro- " ved highly beneficial"; and, in another place he fays, " every thing that relaxes the " fkin by external application alfo forwards " the cure. The contractions of the hams, " and the livid hardnefs of the calves of the " legs are relieved by emollient cataplafms. " Burying the legs in the earth which has a " fenfible good effect feems to act on the fame " principle. It makes the parts fweat pro- " fufely". Now, from this fentence, I con- C 45 ] elude that the warm bath is of the utmoft im- portance, becaufe nothing will relax the fkin with more facility than warm water (to ufe the Doctor's term) but as I would exprefs it, ref- tore the action of the capillary veffels; and why burying the legs in the earth fhould poffefs any advantage, over the bath I cannot conceive ; for the whole intention of it appears to be to produce a diaphorefis and I believe nothing poffeffes greater diaphoretic powers than the warm bath. Bathing the feet and legs in warm vinegar certainly has a double advantage. The vinegar alone promotes the venous abforption very much, which is proved by a very fimple experiment, that of applying vinegar to the lips, which turns them pale by increasing the bibulous action of the veins. But when it is joined to fo powerful a ftimulus as heat, it cannot help accelerating the languid circulation in an eminent degree. Dr. Percival mentions a cafe of a lady of tender conftitution, who was fubject to fcorbutic eruptions and enfee- bled by child-bearing, who derived great be- nefit from warm bathing. Neparites.—Any inflammation of the kidneys is termed a nephritic complaint, whe- ther it arifes from a ftone lodged there or C 46 ] any other caufe.—In thofe affections which are very diftreffing indeed, after fufficient evacuations by bleeding, purging, or glyfters, the warm bath has been found highly fervice- able, but when practifed before the above- mentioned evacuations have been ufed, it tends to increafe the morbid action of the veffels of thofe parts. The practice of ufing the warm bath in nephritic affections, is of great antiquity, having been recom- mended by Hippocrates andCelfus, as quoted by Van Sweeten. It has been ufed with ad- vantage in almoft all inftances of complaints of the urinary organs. Doctor Fothergill derived confiderable relief from it in his lafl illnefs, which was a difeafe of the bladder. There is a cafe related by Dr. Darwin, of fuch an extraordinary cure, that it may not be improper to tranfcribe the whole of it. " Mr.----, fays he, had for many months " been affected with an ulcer in perineo, " which communicated with the urethra, " through which a part of his urine was daily " evacuated with confiderable pain, and was u reduced to a great degree of debility. He " ufed a hot bath of 96 or 98 degrees of heat " for half an hour, during about 6 months. " By this agreeable ftimulus repeated thus at C 47 ] " uniform times, not only the ulcer healed " contrary to the expectations of his friends, " but he acquired greater health and " flrength than he had fome years previously " experienced." Warm fomentations applied to the region of the lions have been ufed with great fuccefs, when it has been inconvenient to practife the bath, either on account of the patient's feeblenefs, or becaufe the pain was fo fevere that he could not be moved. Leprosy is a difeafe that is rarely met with at prefent, efpecially in this country. There are fome inflances of it in the Weft- Indies. As it appears to be a difeafe of the fkin, and the warm bath acts immediately on the fkin, we may conclude it would be pecu- liarly ferviceable, and accordingly we find it recommended in leprous complaints. The warm bath is ufed in moft difeafes of the fkin with manifefl advantage, though we muft not expect a complete cure from this remedy alone. To enumerate all the affec- tions of the fkin in which it has been prac- ticed, would be very tedious and not at all interefling ; but there is a difeafe vulgarly called the furfeit, in which I fhould deem it valuable, though I have perufed no author who recommends it. The warm bath hath II C 48 ] been ufed after the efflorefcence in fcarlatina with finking benefit. " Patients labouring under confluent fmall- pox have been much relieved by it, efpecially if there be any convulsions or apoplectic slumbers. The tepid effusion has been re- commended and found highly ferviceable in that ftate of the fyftem which fucceeds the exceffive ufe and abufe of fpirituous liquors. Dr. Darwin relates a cafe of hectic fever, in which the patient was greatly relieved by the affufion of tepid water; in fome cafes hectic paroxyfms are completely extinguished by it, when practifed in the commencement of the hot ftage. The warm bath has been recommended in almost all the difeafes of women with appa- rently good effects. It has been much extolled in difficult labours ; but it is nearly super- ceded by the lancet at prefent, which is fup- pofed more efficacious, and certainly is more convenient. However, I am of opinion, that when practifed together, the defired purpofe will be obtained with more facility and expe- dition. We fhould be extremely cautious in our recommendation of it, when we have the leafl reafon to fufpect the phlogiftic diathefis exifts in the fyftem—for in that cafe we fhould C 49 ] act as inconfiftently as a perfon would, who fhould attempt to extinguish a flame by pour- ing oil on it. This is the reafon why puer- peral fever has fo often proved fatal after its ufe. But this ftate of fever is fo well under- flood by phyficians of the prefent day, that no one who is the leaft acquainted with it, would think of the war.m bath until very co- pious evacuations had been sifed, after which it may be found ferviceable. In all chronic complaints, in debilitated habits, from what- ever caufe they may originate, the warm bath has been very much dreaded, and of courfe neglected both by patients and phyficians, under the idea of the relaxing property af- cribed to it—which in my opinion, is very unjuftly founded. The warm bath I con- ceive, acts in a manner fimilar to all other ftimulants, when in excefs, by inducing in- direct debility ; but when properly accom- modated to the excitability of the fyftem muft promote the due performance of all the func- tions. Dr. Marcard informs us, that he has feen ladies arrive at Pyrmont, fo weak that they could fcarcely* walk, receive eminent relief from bathing in thofe waters, but as I am not treating of medicated waters, this may be thought not applicable to the fubject, yet C 50 ] I do not believe there is that difference be- tween the medicated and fimple baths as has been hitherto fuppofed; and that their fuc- cefs depends more on the change of climate, exercife and perfeverance, than on any pecu- liar property poffeffed by the waters. Ste- rility is faid to be removed by the warm bath, and thereby difconfolate couples rendered the happy parents of a numerous and flourifh- ing offspring. I come now to fpeak on a fubject that is no lefs difficult than interefting, and which I regret I am riot better qualified to enter mi- nutely into, as well on account of the want of time as the length of this effay. The difeafes of children require the moft profound fkill in the practitioner and excite his tender feelings in the moft companionate manner. Moft of their difeafes are fimple and easily managed when underftood and taken in time; but when fuffered to become chronic are fomewhat more perplexing and often prove fatal. There are few difeafes to which the infantile ftate is fubject that the warm bath has not been recommended in; and flill fewer in which it may not be ufed with advantage. In convulsions of all kinds it produces the happieft effects, but even in thefe affections [ 51 ] I am inclined to repeat an obfervation that I have feveral times made, that it would prove much more efficacious when preceded by fome evacuation in children of sanguine tem- peraments. It effected the firfl cure of the difeafe de- nominated fkin-bound, that ever was perform- ed. This is a difeafe of peculiar mor- tality, for near nine tenths of all the chil- dren perifh who are attacked by it. Children are frequently much oppreffed with obftinate conflipation, and after all other remedies have failed, the warm bath has re- lieved the little fufferers and fnatched them from the jaws of apparently inevitable death. When children are fo troubled with worms as to occafion obftinate contractions of the nmfcles situated on the extremities, the warm bath is effentially neceffary. To enumerate all the difeafes of children in which this remedy is recommended would be a ufelefs tafk for me, fince I can refer to fo many authors who have written exprefsly on them, and detailed their caufes, fymptoms, and cure, with a perfpicuity and judgment, which do the higheft honor to their names. The Indians are fubject to few difeafes, though thefe are of the moft violent and in- [ 52 ] rlammatory kind; for the cure thereof they ap- ply the moft powerful remedies, which either kill or cure immediately. Pleurisies and rheu- matifms are the difeafes which moft frequent- ly occur. The principal remedy they prac- tife in them is the warm bath, which they ap- ply to the body in form of vapour. Their method of ufing it is this : They prepare a bagnio refembling a large oven into which they introduce feveral hot ftones : the fick person then creeps into it and the water is immediately poured on the flones. After remaining there about half an hour, the patient runs to the river into which he plunges himfelf two or three times. He then returns to his wigwam, or houfe, paffing through the bagnio to mitigate the immediate stroke of the cold, when wrapping himfelf in a blanket he lies down near a gentle fire turning himfelf frequently till dry, when he gets up and goes about his bufinefs as ufual. The Ruffians and Siberians have a prac- tice of ufing the warm bath fimilar to the In- dians, by confining themfelves in a clofe place, and pouring water on heated flones till they raife the temperature to 148, and even occasionally to 168 degrees of Fahren- heit's thermometer. In this intenfe heat they C 53 ] remain fometimes for two hours; frequently pouring hot water on their bodies—then they rufh into the open air and roll themfelves in the fnow, when the temperatsire of the atmof- phere is 10 degrees below Zero. Many chro- nic difeafes are faid to be cured by this reme- dy : and the rheumatifm is faid to be almoft unknown in Ruffia. We are informed by travellers, that every perfon, from the fove- reign to the meanest peafant, ufes fuch arti- ficial hot baths twice a day. There are many other difeafes, in which the warm bath has been ufed with fuccefs; but thofe that have been mentioned are fuf- ficient to fhew its efficacy. With my beft wishes for the profperity of the Univerfity of Pennfylvania, I clofe this imperfect fketch of my youthful fludies. FINIS. IMZ 1*01 ^ I m TJHUdB! 11 m*. m aSjp*T» w|sia wwiil KmlTs »^W«tE}£ t'-Jijn'4^ Hi « ^;a- -#i-^ '^< &$ ms '$.* 'PWI^&M rO*