The Hydriatic Treatment of Pneumonia. 
BY 
R. K. MACALESTER, M. D. 
GLEN WOOD SPRINGS. 
Read before the Colorado State Medical Society. THE HYDRIATIC TREATMENT OF PNEUMONIA. 
R. K. MACALESTER, M. D., GLENWOOD SPRINGS. 
In the limited time allotted to me for the discussion of hy- 
drotherapy in pneumonia I shall endeavor to cover as much 
ground as possible by presenting in the form of a brief resumd 
the well established data of this rather extensive subject. Those 
wishing to familiarize themselves with details will find this 
branch of therapeutics elaborately treated in a recently pub- 
lished book by Dr. S. Baruch,* of New York, to whom, indeed, 
as to Winternitz in Europe, great credit is due for the develop- 
ment and propagation of hydrotherapeutics in this country. I 
was fortunate enough to have had instruction from both the 
aforenamed authorities, from which, as well as from their writ- 
ings, I shall quote freely, without special reference, in the follow- 
ing. 
Many observers of the widest experience in the treatment 
of pneumonia by various methods extol the virtues of hydro- 
therapy, and comparative statistics demonstrate its therapeutic 
efficiency. Thus, for instance, Dr. Fenwick of the London Hos- 
pital in an analysis of 1,000 cases of pneumonia met with failure 
in but 10$ of those treated by various cold applications, whereas 
the mortality was double as great when other methods were em- 
ployed. Tn the J. Hood Wright Memorial Hospital of New 
York the total mortality from pneumonia has been reduced over 
one-half since hydriatic treatment has been adopted. Penzoldt, 
from the experience of an enormous material of 2,200 cases of 
pneumonia in children, concludes that preference should always 
be given to a cautious bath treatment. 
By first considering some of the physiological effects of cold 
applications to the body surface, we can best judge as to their 
*S. Baruch: Hydrotherapy, N. Y., Win. Wood & Co., 1898. See also: Hydrotherapy 
in the Pneumonia of Children, Med. Mews. Nov. 19, 1898; and Winternitz : Dio. 
Hydrotherapie auf physiol, and klin. Grundlage, Vienna and Leipsig, 1890 4 
applicability and to what extent they meet the therapeutic indi- 
cations in pneumonia. A moderately cold application to the skin 
causes a primary contraction of the cutaneous vessels which is 
followed by a tonic active dilatation, in contrast to the passive 
hyperaemia produced by warm procedures (as, for instance, poul- 
tices). These latter relax the vasoconstrictors, giving rise to a 
stasis, whereas cold stimulates the vasodilators, producing an ac- 
tive hyperaemia with maintenance of va'scnlar tone and improved 
circulation. Mild cold procedures—such as usually employed in 
pneumonia—act reflectively through stimulation of the 
cutaneous nerves upon the centers in the central nervous sys- 
tem and thence upon the functional activity of various organs. 
The respiratory system is stimulated and inspiration deepened. 
The effect on the circulatory system is stimulation of the heart 
action (evinced by more forcible ventricular contractions), and 
neurovascular excitation, in consequence of which arterial ten- 
sion is raised and the blood propelled with greater velocity and 
force. The general condition is invigorated and refreshed, and 
cerebral activity stimulated. The secretory organs evince 
greater activity, the amount of secreted urine, for instance, in- 
creasing considerably. Owing to the compensatory powers of 
our body, internal temperature is not materially influenced in 
health. 
By applying the foregoing data we shall see that the thera- 
peutic requirements in pneumonia are thereby well fulfilled and 
that hydriatic treatment is based on a sound rationale. 
The therapeutic indications are: “(1) To stimulate and invig- 
orate the nerve centers, with a view to enhancing the patient’s 
vital powers; (2) to prevent and control heart failure; (3) to re- 
duce temperature; (4) to eliminate toxins.” (Baruch.) 
ad 1. The stimulating action of cold applications upon the 
nerve centers is reflected to organs of vital importance, upon 
whose functions the patient’s resisting powers to the toxic sub- 
stances generated by the diplococcus pneumoniae of Fraenkel 
are dependent. Soon after applying cold the patient grows 
calmer, respiration deeper and more regular, dyspnoea is re- 
lieved, and expectoration facilitated. There is also improvement 5 
of appetite and sleep and of the functions of the skin and kid- 
neys. 
ad 2. Heart failure, the most dreaded complication in pneu- 
monia, is better averted by hydriatic measures than any other 
available means. The heart action is aided and maintained in 
the following manner: The active liyperaemia of the skin, fol- 
lowing the rapid primary contraction of the cutaneous vessels, 
relieves the heart at once by broadening the stream in the 
cutaneous capillaries. At the same time arterial tension is 
raised, as proved by the better filling of the radial arteries, and 
a freed, unembarrassed pulmonic and systemic circulation is 
established. When we consider the enormous vascular area of 
the skin, estimated as being capable of holding 30 to 50 per cent, 
of the entire blood of the body, we can readily realize that this 
is a mighty source of depletion. 
ad 3. The fact that pneumonia patients are extremely sus- 
ceptible, and that their temperature may be easily reduced by 
cold procedures, necessitates great care and precaution in the 
application of such measures. Although high temperature may 
be an important element in pneumonia and other infectious dis- 
eases by imposing more work upon the heart and adding greatly 
to the patient’s discomfort, still it is bj’ no means the chief dan- 
ger. As I have oftep insisted in discussing the matter, fever is 
but a symptom of disease, indicating the reaction on the part of 
our organism in its struggle to overcome the infective process. 
If vitality sinks so low as to offer no resistance to the toxaemia, 
there is no fever, and the patient collapses at once—an occur- 
rence which we have all had occasion to observe in lethal cases 
of pneumonia. Therefore the indiscriminate administration of 
antipyretics, with a view of reducing temperature and thereby 
meeting the principal therapeutic indication, is as fallacious as 
is the idea so deeply rooted in the professional mind that the 
main attribute of hydrotherapy in febrile diseases is reduction of 
temperature. 
ad 4- The support that cold applications give to the nervous 
system, raising flie patient’s vitality and the functional activity 
of various organs, is conducive to the elimination of toxins. 6 
The hydriatric methods in pneumonia. Owing to the suscepti- 
bility of pneumonia patients to cold, the milder hydriatric proced- 
ures, such as the cold chest compress or the wet pack, are indi- 
cated in general. Furthermore, these are more easily applied 
and controlled, and are attended by less agitation, disturbance 
and exertion on the patient’s part. In others’ as well as in my 
own experience the milder measures are indeed quite adequate 
to fulfill all the therapeutic requirements in both the croupous 
and catarrhal pneumonias of adults. 
The cold chest compress is preferable to other procedures in 
pneumonia—a conclusion I had reached independently some time 
ago, and which I now find is in harmony with the opinions of 
some others. Its correct application, as all hydriatric proced- 
ures, requires some experience and care, therapeutic failures be- 
ing usually due to faulty technique. The chest compress is com- 
posed of three folds of linen or old muslin, cut in a manner to fit 
the entire chest from above the clavicles down to the umbilicus, 
with slits in the axillary region to form flaps and cover the shoul- 
ders. It is then wrung out of water, so that it does not drip, at 
the temperature of 00° F., snugly applied around the thorax, 
covered with a piece of closely woven thin flannel of the same 
shape but at least an inch wider in all directions, and secured 
by safety pins. At first the application is changed every half 
hour, then every hour or two until the patient’s temperature is 
below 100° when it may be discontinued. The compress should 
not be covered with oiled silk—a very popular proceeding on the 
part of attendants for the sake of convenience and protection of 
the patient’s bed and clothing—as this would convert it into a 
poultice and deprive it of its stimulating and gradually cooling 
action. 
The wet pack, at the temperature of G0° to 70° F., being a 
somewhat more severe procedure than the chest compress, is in- 
dicated in the graver forms of pneumonia with high tempera- 
ture. It is a very popular and efficacious method, has warm ad- 
vocates, and deserves special mention.* 
* While 1 was attending Profpssor Winternitz’s clinic in Vienna, this method was em- 
ployed extensively in pneumonia with excellent result0. 7 
Other hydriatric methods in pneumonia, advocated by prom- 
inent observers, are: Cold full baths, temperature G0° to 70° F.; 
tepid baths, 00° to 92.5° F., both with or without friction and 
ablutions; ice-packs; the ice cradle; cold sponging, etc. 
In the pneumonia of children, the same methods as enumer- 
ated in the foregoing for adults are employed in somewhat modi- 
fied form. The child’s sensitive nervous organization, with its 
greater susceptibility to cold and to the development of nervous 
symptoms and the minor resisting powers of the heart as com- 
pared with the adult’s, render sound judgment in prescribing, 
and extreme care in the application of, hydriatic procedures 
imperative. 
In my experience, based on the observation of a considerable 
material treated during my practice in New York, the cold chest 
compress alone proved a reliable and adequate remedy in the 
vast majority of cases. For children under three years of age 
Baruch favors tub baths of five to eight minutes’ duration, with 
continuous friction at the temperature of 95° gradually reduced 
to 85° or 80° F. according to the body temperature, whereas in 
older ones preference is given the cold chest compress. He also 
recommends the copious administration of cold water at regular 
intervals in the pneumonia of both children and adults, and I 
need scarcely add that a hygienic regime should be strenuously 
adhered to. 
Epicrisis. The virtues of hydrotherapeutics, being based on 
sound principles and scientific clinical evidence, entitle them as 
much to adoption by the profession at large as do the popular 
medicinal remedies in routine practice. I do not presume to say 
that drugs can be dispensed with; they have their place and field 
of usefulness; but their prolonged administration is often de- 
pressive to the one or other organ, is toxic or nauseating, etc., and 
they do not always fulfill the requirements of judicious treat- 
ment. In support of this view, and in connection with the pneu- 
monia of children, allow me to detail an illustrative case from 
my past experience: 
H. It., a well developed girl, years old, was taken ill after 
measles with pneumonia five days previous to my first visit. I 8 
saw at a glance that her condition was very serious, and on ex- 
amination found the entire lower and middle lobe of the right 
lung consolidated. The temperature was 103.2°, the pulse 
scarcely appreciable, approximately 160, the breathing rapid, 
superficial and obstructed.; the lips and extremities were mark- 
edly blue from cyanosis, and the child lay there failing fast, 
somnolent, and at times agitated. On enquiry I ascertained that 
she had been given various kinds of medicines, all of which were 
inefficacious and promptly ejected, during the last two days, and 
it was with difficulty that any nourishment could be retained. 
I demonstrated to the parents how to use the cold chest compress 
by applying the first one myself, prescribed a simple expectorant, 
and waited to observe the result. In about an hour improve- 
ment began. The cyanosis disappeared, the pulse became 
stronger and slower, the respiration deepened, cough and expec- 
toration set in, consciousness returned, and, in short, the child 
was actually resuscitated. Shortly afterward she fell into a 
peaceful sleep. From then on she progressed uninterruptedly 
and was convalescent two days later. 
In conclusion, I venture to state that anybody who has wit- 
nessed a few such transformation scenes as the one just de- 
scribed, resulting from the correct application of water after me- 
dicinal agents have proved futile, will become a convert to hydro- 
therapy.