Nursing in Hydrotherapy

Author(s): Bertha Kruer

Source: The American Journal of Nursing, Vol. 5, No. 6 (Mar., 1905), pp. 361-366
Published by: Lippincott Williams & Wilkins
Stable URL: http://www.jstor.org/stable/3401893
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Nursingin Hydrotherapy.-Kruer

361

NURSING IN HYDROTHERAPY
BY BERTHA KRUER, R. N.
Graduate Mt. Sinai Training-School,New York City

HYDROTHERAPY
is a branchof therapeuticsin which the nurse is
probablya more importantfactor than in any other departmentof the
treatment of diseases. Electro-therapy,dieteto-therapy,and climatotherapyare some of the other divisionsof therapeutics; in the latter
two the physicianprescribesand the patient executesthe prescription
at his own sweet will; in the formerthe physieianhimself usually administersthe remedy. In hydrotherapy,however,physicianand patient
alike are helplessif the nurseis not readyto executethe prescription.
The fact that there is no branchof nursing so much slighted in
training-schoolsas the applicationof water in diseases accounts for
manyfailuresof this valuableagent which are daily observedand which
have served to prevent its more universal adoption, and only when
physiciansand nurses will begin to study the science of hydrotherapy
will humanity get the full benefit of this far-reachingand thorough
medicinalagent.
It is not my intention-in fact, it is impossible in this brief
paper to describethe many variousmethodsin which water may be
applied. Dr. SimonBaruchcontemplatesthe issuingof a workon " The
Techniqueof Hydrotherapyfor Nurses,"a book which will cover the
entire field. My obJectis to point out a few plain facts, give some
practicalhints, and to arouseand stimulatethe interestin this so sadly
neglectedbranchof nursing.
We all know that the nurse who is thoroughlygroundedin the
principlesof her profession-i.e., in the reasonswhy the medicine,food,
water,and stimulantare given, why the characterof the respirationand
pulse must be observed,why the color,quantity,and qualityof the urine
must be noted will becomethe most efficientaid to patient and physician. Such a nursewill alwayspresenta moreintelligenthistoryof the
case from which the doetormay obtain the most valuableclues for the
propertreatmentof the patientthan one who mechanicallyreportswhat
is observed. It thereforebecomesof prime importancethat the nurse
be instruetedin the generalprineiplesof hydrotherapy.e., why water
is to be applied,why the temperature,the mode,and the durationof the
applicationare to be strictly guardedand the effect noted and reported
to the physician.
IIydrotherapyis the applicationof waterin diseases,the wordbeing
derivedfrom two GEreek
wordssignifying" to heal" and " water." This

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362

T7beAmericanJournal of Nursing

wordshouldbe distinguishedfrom hydropathy,the devoteesof which

believein water as the universalcurativeagent. Every well-informed
nurseknowsthat thereexistsno universaleurativeagent.
Hydrotherapydependsupon waterfor remedialeSects chieflyas a
medium of conveyingtemperature. It is not the water alone which
acts upon the humansJTstem,
but the cold and heat conveyedthroughit
to the skin (mostly). A little coldwaterpoureddownthe backsuddenly
often stops nose-bleed;a cold key does the same. WValking
brisklyin
the cold air bringseolorto the cheeks,just as bathingthe face in cold
water with good friction does. Both are due to the same cause: the
irritating,excitingeffectof cold upon the fine nervesand blood-vessels
of the skin, which resultsin reaction. IIence iron and air, conveying
temperature,are as useful as water. The reasonwhy water has been
preferablyselectedfor this purposeis that it may be appliedin the
solid, liquid,and vaporizedform, that the force or pressurewith which
it is appliedmay be mathematicallymeasuredas also its temperature,
that it affordsnumeroustechnicaladvantagesin its application,and
that it absorbsand gives ofEtemperaturebetterthan any otheragent.
The skin is the rnostfrequentpart of the bodyon whichthe action
of waterfor remedialpurposesis expended. The reasonfor this is not
far to seek. The skin is an enormousnetworkof fine nervesand bloodvessels,as is evidentto the most superfiefalobserverby plunginga fine
needleinto it. Pain announcesthe preseneeof a nerve,the flowof blood
testifiesto the presenceof a blood-vessel.Noavif it be bornein mind
that this fineneedlehas struck(irritated,as the phSTsiologist
calls it) the
end of a nerve,the origin of whichanatomistshave distinctlytracedto
the brain and spinal cord (the centralnervoussystem), and that this
nervoussystem presidesover all the functions and furnishesall the
powerof everyorganin the humanbody,is it not clear that any agent
which can thus influencethe skin nervesmust be powerfulfor good or
evil in its influenceupon the human body? And this is a most
importanttruth!
Again, the minute blood-vesselsof the skin, from which a needle
drawsblood,are but the outlyingterminalsof that vast systemcalled
the circulation,which derivesall its powerand force from the heart.
If the needle only scratchesthe surfaceof the skin, there appearsa
brightred streak,whichmeansthat this irritationhas causeda dilatation
of the minute blood-vessels.Now, inasmuchas the circulationin the
skin is so readilyaffectedby an applicationof the pointof a needle,is it
not logicalto say that the wholecirculationof whichthe skin-vesselis
a partmaybe thus influenced? But we shall not be contentwith reason

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Nqmrsing
in Hydrotherapy. ZKrqler

363

and logic. As nurses,standingat the bedsideof a sufferingpatient,we

shall apply this reasoningand this logic in orderto reachconuction.
lIow can we demonstratethat the irritationof the end-nervesin the
skin affectsthe brain?
Dash a cup of cold water upon the chest of a fainting person!
Coldis an irritantjust like the needle. If the needlescratchesthe skin,
it producesan unpleasantsensation; if it penetratesmore deeply, it
producespain and damagesthe skin. A dash of cold water produces,
like the needle, an unpleasantsensation; if it is appliedlonger in the
shape of ice, it too producespain; it too would damagethe skin if
retained long enough to freeze the part. Scratchingthe skin with a
needledoesnot arousea fainting person; it wouldrequiremanyneedles
appliedto a large surfaceto so irritate as to stimulatethe depreciated
brain to resumeall its functions. A dash of cold water irritatesa considerablesurface,stimulatesthe nervesbeneathit; this stimulationis
conveyed,as physiologyteaehes, directly by the sensorynerves to the
brain. That the latterfeels the stimulusis manifestedby the gaspwhich
ensues. This gasp is nothing more than the reflex effect of the brain
stimulus. Breathingis resumed,the color rushesto the pallid lips, the
eyes brighten,the wheels of life, temporarilycheckedby syncope,are
againin motion. Coldappliedto the skin nerveshas workedthis marvel.
Is there any medicinethat can accomplishit? :Hereis the principleof
hydrotherapyin a nutshell. How does the physicianapply it? The
small nerve area which is stimulatedby the dash of cold water to the
chest or face sufficesto arousea fainting person. But this small dose of
cold water would have no effect on a case of opium poisoning. Here
we need a bucketof cold water or a strong douchefrom the nozzleof a
hose. And even this is often insufficient. In the stupefiedconditiono
a typhoida dash of cold waterwouldnot be enough. He needs a larger
dose; we put him into a tub of water at a temperatureadaptedto his
case; he is aroused,his face brightens,his pulse improves. The effect
of this large dose of stimulantto his entire skin area of nervesis conveyedto the brain; the latter is refreshedand enabledto furnish more
powerto the heart and the lungs, and thereforethe whole machinery
of the organismis stimulated,sustained,invigorated. Again the patient
lapses into stupor, as the effect of the bath passes away; again he is
tubbed and rubbed,the duration and temperatureof the bath being
judiciouslyadaptedby the physician.
Surelythis demonstrationmust convincethe most scepticalthat the
actionof cold water,excitedthroughthe skin, upon the wholeorganism
is momentous,and that it may be adaptedor dosedto varyingconditions

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364

The Arrerican
Journalof Nursing

as no other remedycan be adapted. But how is this dosing of water

esternallyappliedaccomplished?
NVedose medicinalagentsby weight or measureand frequencyof
administration.Wateris dosed:I, by its temperature;2, by the duration of its application; 3, by the pressureor force with which it is
applied; and 4, by the methodof the application.
1. That the effectof waterat 34 F. is very differentfrom that of
waterat 110 F. is a trite fact. This beingtrue, everyfew degreesmore
or less must furnishdifferentresults.
2. That the duration of the applicationof water of the same
temperatureinfluencesits effect is not so well known. Plunge one
hand into a bucketof water at 40 F. for a second,removeand dry
it; the result will be a suddenchilling, followedby reactionor rapid
warmingof the hand. Dip the otherhandinto the samewaterand leave
it for five minutes. The result will be chilling followedby numbness,
succeededby pain. On withdrasal the hand will be cyanoticand will
requiremuch friction to warm it or producereaction. The same indindual and the sametemperatureare usedin this experiment,only the
durationis changed. How diSerentthe result! If the effectvariesso
greatly,may we not obtainmoremoderateand tretvaryingeffectsfrom
lesser diSerencesin duration?
3. That the effectof waterappliedwithoutpressureor forcedifers
greatly from that of water appliedwith force is readilydemonstrated
by sprayinga patientsufferillgfrom depressedneurastheniawith water
at 80 F., and treatingthe samepatientafterwardswith a douche,deliveredunderthirty-poundpressure. The formerwill chill the patient,
the latter will arouseand stimulatehim.
4. That the procedure,or mode of applyingwater, influencesits
effect may be demonstratedby washing or sponging a fever patient
(ablution) with waterat To F. and at anothertime applyingthe same
quantityof waterand of the sametemperatureas an efusion .e. by
pouringit overhis head and shouldersfrom a basin. The formermay
sootheand cool him, the latter will refreshand stimulatehim.
It follows,therefore,that the procedureby whichthe wateris to be
administered,the durationof its application(in chroniccases also the
force), and the temperatureof the water are of- greatestimportance.
If the physicianprescribesa cold sponging,it is the duty of the nurse
to ask him at what temperatureand of what duration. If a pack is
ordered,the nurseshouldascertainwhethera drypackor a wet pack,of
what temperatureand duration,and whetherit is to be followedby dry
frietion, an alcoholrub, an ablution,or an effusion (in the latter two
the temperatureof the wateralso shouldbe mentioned).

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Nurssng in Hydrotherapy. Xrqler

365

The terms cold water, warm water, and hot water are exceedingly
indefinite; hence the temperatureof the watershould alwaysbe stated.
The greater the differencebetweenthe temperatureof the water and
that of the skin the more intense the so-called shock will be, and
thereforethe more intense the efect. It is clear that a fever patient
whose skin temperatureis 102 F. will feel water at 90 F. as cool,
while to a normalpersonwhoseskin temperatureis 90 F. waterat this
temperaturewouldbe indiferent. All efects of coldor coolwaterdepend
uponthe reactionproducedby it.
Illasmuch as the reaction differs greatly with the amount of socalled "shock,' it is necessarythat these terms be more fully understood. In speakingof a " shock"producedby cold water we are accustomedto think of (' shock"as a depressionof the vital powers,because
we are used to dealingwith surgicalshock,arldthe true definitionof the
latter is a ;' depressionof the vital powers.' But thereis anotherdefinition of shockin our dictionaries viz., an unpleasarltsurprise. We hear
some sad news, we are shocked,but not necessarilyenfeebledin our
vitality. This is the shock of cold water upon the skin; it is an unpleasant surprise to the fine nerves and blood-vesselsof the skin a
surprise,however,which results in the pleasantsensationcalled (; reaction," if the cold water has been judiciouslyused. A fainting person
receivesan unpleasantsurprisefrom cold water; reactiontakes plaee
and he awakens.
The chief aim of all cold applicationsbeing reaction, it is important for the nurse to clearly estimate the nature of this process.
When a patient shivers for a considerabletime during and especially
after an applicationof cold water, it is an evidencethat reaction is
absent; thereforethe applicationis not safe. When a ever patient,
however,simply feels cold during a cold bath orderedby the physicianf
though he protestsvigorouslyand even shiversa little, he must not be
removed. Not vlnlessthe teeth chatterand eyanosisof the lips ensues,
or the shiveringamountsto a severechill, shouldthe nurse feel authorized to abbreviatethe prescribeddurationof the bath. Therein much
skill and Judgmentare required; hence the aboverule wouldbe a safe
guide. It is a well-knownfact that good friction durlg the bath prevents chill and promotesreactionafter the bath. It is a safe rule in all
cold applicationsneverto applycold waterwithoutgood friction,and to
always insure reaction. If hot bottles and restorativesmust be used
after a coldprocedure,the temperatureof the waterhas probablybeentoo
low or, whatis morelikely,the durationhas beentoo long. A full bathin
water at 75 F. for fifteen minutes may chill the patient, whereasa
simple dip or a bath of five minutes in the same water would refresh

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366

The AmericanJournal of Nursing

and stimulatehim. It wouldbe a seriouserrorto raise the bath temperatureand continuethe durationfor fifteenminutes. Reactionis more
favoredby brief applicationsat low temperaturethan by prolonged
applicationsat highertemperatures.To makethe eSect enduring,however, the cold applicationshouldbe as long as the reactivecapacityof
the patientadmits.
Anothergoodrule in maliingcold applications(ablutions,effusions,
etc.) is to omit washing the upper estremitiesbelow the elbowsand
the lower estremitiesbelowthe knees. The circulationin these parts
beingfeeblein sickpeopleon accountof absenceof esercise,theirreaction
is feeble.
Then again it is well to know how to make cold ablutions,etc.,
rapidly,dryingeachpartbeforeproceedingto the next. Chillingis thus
preventedand reactioncorrespondingly
promoted.
That a nurseshouldstrictlyfollowthe physician'sdirectionsis one
of the fundamentalrules of good nursing,but hydrotherapiedemands
of a nurse more self-relianceand individualinitiative than any other
modeof treatment.

HOPITAL GENERAL, RHEIMS

Bs E. N. LA MOTTE
GraduateJohns Hopkins Training-School

RHEIMS
is an old Frenchtown with a populationof a little overa
hundredthousand,and situatedrather ofEthe usual tourist track in
fact, one must go to Rheimsdeliberately;it is not to be reachedby
getting ofEthe train en route for somewhereelse; but it has not been
equallyfortunatein getting off the route of marchingarmies,which
from Romandays downalmostto our own have almTays
includedit in
their line of progressand have left UpOll it their ilupress. :EIere,in
496, Cloviswas baptizedand embracedChristianity. And here, also,
after the twelfth century,nearlyall the FrenchWingswere crownedin fact, it seemsas if everystreet and house,and even the very cobblestonesof the quaintold eity, are rich in memoriesand associationswith
an historicand importantpast. It is not, therefore,a surpriseto find
that the large old Hopital Generalhas its associationslikewise,and
that it was duringthe FrenehRevolution,and probablybeeauseof it,
that it wasconvertedfromits originaldesign,that of a Jesuit monastery,
and turnedoverto its presentuse. The monasterywas built aboutthe

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