Hydrotherapy

Hydrotherapy, formerly called hydropathy, is probably the oldest form of medical treatment. It involves the use of water for soothing pains and treating diseases.

Its use has been recorded as early as ancient Egyptian, Greek and Roman civilizations. Egyptian royalty bathed with essential oils and flowers, while Romans had communal public baths for their citizens. It has been long accepted that hot water springs can improve health by increasing circulation. Hippocrates prescribed bathing in spring water for sickness. A Dominican monk, Sebastian Kneipp again revived it, during the 19th century. His book My Water Cure in 1889 was published and translated into many languages.

The use of water to treat rheumatic diseases has a long history. Today, hydrotherapy is used to treat arthritis, burns, spasticity, ankylosing spondylitis, musculoskeletal disorders, spinal cord injuries, and stroke patients with paralysis. It is also used to treat orthopedic and neurological conditions in dogs and horses, and to improve fitness.

Immersion in water - and doing exercises in water - has always been a popular therapy. Thousands of years of treatments have built an enormous amount of expertise, but the alleged benefits had little supporting evidence from science until approximately 30 years ago. A 2006 survey of research in Annals of the Rheumatic Diseases discusses the vast amount of high-quality studies showing the effectiveness of hydrotherapy. A new field of research focuses on the cost-effectiveness of hydrotherapy vs. other forms of treatment.

The following material is from the 1911 Encyclopedia Britannica, and thus represents the state of the field at the beginning of the 1900s.

Like many descriptive names, the word "hydropathy" is defective and even misleading, the active agents in the treatment being heat and cold, of which water is little more than the vehicle, and not the only one. "Thermotherapeutics" (or "thermotherapy") is a term less open to objection.

History
Hydropathy, as a formal system, dates from about 1829, when Vincent Priessnitz (1799-1851), a farmer of Gräfenberg in Silesia, Austrian Empire, began his public career in the paternal homestead, extended so as to accommodate the increasing numbers attracted by the fame of his cures. Two English works, however, on the medical uses of water had been translated into German in the century preceding the rise of the movement under Priessnitz. One of these was by Sir John Floyer (1649 1734), a physician of Lichfield, who, struck by the remedial use of certain springs by the neighboring peasantry, investigated the history of cold bathing, and published in 1702 his IvxpoXovoLa, or the History of Cold Bathing, both Ancient and Modern. The book ran through six editions within a few years, and the translation was largely drawn upon by Dr J. S. Hahn of Silesia, in a work published in 1738, On the Healing Virtues of Cold Water, Inwardly and Outwardly applied, as proved by Experience. The other work was that of Dr James Currie (1756-1805) of Liverpool, entitled Medical Reports on the Effects of Water, Cold and Warm, as a remedy in Fevers and other Diseases, published in 1797, and soon after translated into German by Michaelis (1801) and Hegewisch (1807). It was highly popular, and first placed the subject on a scientific basis. Hahns writings had meanwhile created much enthusiasm among his countrymen, societies having been everywhere formed to promote the medicinal and dietetic use of water; and in 1804 Professor Ortel of Ansbach republished them and quickened the popular movement by unqualified commendation of water drinking as a remedy for all diseases. In him the rising Priessnitz found a zealous advocate, and doubtless an instructor also.

At Gräfenberg, to which the fame of Priessnitz drew people of every rank and many countries, medical men were conspicuous by their numbers, some being attracted by curiosity, others by the desire of knowledge, but the majority by the hope of cure for ailments which had as yet proved incurable. Many records of experiences at Gräfenberg were published, all more or less favorable to the claims of Priessnitz, and some enthusiastic in their estimate of his genius and penetration; Captain Claridge introduced hydropathy into England in 1840, his writings and lectures, and later those of Sir W. Erasmus Wilson (1809-1884), James Manby Gully (1808-1883) and Edward Johnson, making numerous converts, and filling the establishments opened soon after at Islalvern and elsewhere. In Germany, France and America hydropathic establishments multiplied with great rapidity. Antagonism ran high between the old practice and the new. Unsparing condemnation was heaped by each on the other; and a legal prosecution, leading to a royal commission of inquiry, served but to make Priessnitz and his system stand higher in public estimation.

Increasing popularity diminished before long that timidity which had in great measure prevented trial of the new method from being made on the weaker and more serious class of cases, and had caused hydropathists to occupy themselves mainly with a sturdy order of chronic invalids well able to bear a rigorous regimen and the seventies of unrestricted crisis. The need of a radical adaptation to the former class was first adequately recognized by John Smedley, a manufacturer of Derbyshire, who, impressed in his own person with the seventies as well as the benefits of the cold water cure, practised among his workpeople a milder form of hydropathy, and began about 1852 a new era in its history, founding at Matlock a counterpart of the establishment at Gräfenberg.

Ernst Brand (1826-1897) of Berlin, Raljen and Theodor von Jurgensen of Kiel, and Karl Liebermeister (1833-1901) of Basel, between 1860 and 1870, employed the cooling bath in abdominal typhus with striking results, and led to its introduction to England by Dr Wilson Fox. In the Franco-German War the cooling bath was largely employed, in conjunctior frequently with quinine; and it now holds a recognized position in the treatment of hyperpyrexia. The wet sheet pack has become part of medical practice; the Turkish bath, introduced by David Urquhart (1805-1877) into England on his return from the East, and ardently adopted by Richard Barter, has become a public institution, and, with the morning tub and the general practice of water drinking, is the most noteworthy of the many contributions by hydropathy to public health.

Form of hydrotherapy
The appliances and arrangements by means of which heat and cold are brought to bear on the economy are(a) Packings, hot and cold, general and local, sweating and cooling; (b) hot air and steam baths; (c) general baths, of hot water and cold; (d) sitz, spinal, head and foot baths; (e) bandages (or compresses), wet and dry; also (f) fomentations and poultices, hot and cold, sinapisms, stupes, rubbings and water potations, hot and cold.

Packings
The full pack consists of a wet sheet enveloping the body, with a number of dry blankets packed tightly over it, including a macintosh covering or not. In an hour or less these are removed and a general bath administered. The pack is a derivative, sedative, sudorific and stimulator of cutaneous excretion. There are numerous modifications of it, notably the cooling pack, where the wrappings are loose and scanty, permitting evaporation, and the application of indefinite duration, the sheet being rewetted as it dries; this is of great value in protracted febrile conditions. There are also local packs, to trunk, limbs or head separately, which are derivative, soothing or stimulating, according to circumstance and detail.

Hot air baths
Hot air baths or saunas, the chief of which is the Turkish (properly, the Roman) bath, consisting of two or more chambers ranging in temperature from 120° to 212° or higher, but mainly used at 150° for curative purposes. Exposure is from twenty minutes up to two hours according to the effect sought, and is followed by a general bath, and occasionally by soaping and shampooing. It is stimulating, derivative, depurative, sudorific and alterative, powerfully promoting tissue change by increase of the natural waste and repair. It determines the blood to the surface, reducing internal congestions, is a potent diaphoretic, and, through the extremes of heat and cold, is an effective nervous and vascular stimulant and tonic. Morbid growths and secretions, as also the uraemic, gouty and rheumatic diathesis, are beneficially influenced by it. The full pack and Turkish bath have between them usurped the place and bettered the function of the once familiar hot bath. The Russian or steam bath and the lamp bath are primitive and inferior varieties of the modern Turkish bath, the atmosphere of which cannot be too dry and pure.

General baths
General baths comprise the rain (or needle), spray (or rose), shower, shallow, plunge, douche, wave and common morning sponge baths, with the dripping sheet, and hot and cold spongings, and are combinations, as a rule, of hot and cold water. They are stimulating, toxic, idiotic, and deteriorating.

Local baths
Local baths comprise the sitz (or sitting), douche (or spouting), spinal, foot and head baths, of hot or cold water, singly or in combination, successive or alternate. The sitz, head and foot baths are used flowing on occasion. The application of cold by Leiters tubes is effective for reducing inflammation (e.g. in meningitis and in sunstroke); in these a network of metal or indiarubber tubing is fitted to the part affected, and cold water kept continuously flowing through them. Rapid alternations of hot and cold water have a powerful effect in vascular stasis and lethargy of the nervous system and absorbents, yielding valuable results in local congestions and chronic inflammations.

Compresses
Bandages (or compresses) are of two kinds,cooling, of wet material left exposed for evaporation, used in local infiammations and fevers; and heating, of the same, covered with waterproof material, used in congestion, external or internal, for short or long periods. Poultices, warm, of bread, linseed, bran, &c., changed but twice in twenty-four hours, are identical in action with the heating bandage, and superior only in the greater warmth and consequent vital activity their closer application to the skin ensures.

Other
Fomentations and poultices, hot or cold, sinapisms, stupes, rubefacients, irritants, frictions, kneadings, calisthenics, gymnastics, electricity, &c., are adjuncts largely employed.

BIBLIOGRAPHY.AmOng the numerous earlier works on hydropathy, the following are worth mention: Balbirnie, Water Cure in Consumption (1847), Hydropathic Aphorisms (1856) and A Plea for the Turkish Bath (1862); Beni-Barde, Trait dhydrothrapie (1874); Claridge, Cold Water Cure, or Hydropathy (1841), Facts and Evidei~zce in Support of Hydropathy (1843) and Cold Water, Tepid Water ahd Friction Cure (1849); Dunlop, Philosophy of the Bath (1873); Floyer, Psychrolousia, or the History of Cold-Bathing, &c. (1702); J. S. Hahn (Schweidnitz), Observations on the Healing Virtues of Cold Water (1738); Hunter, Hydropathy for home Use (1879); E. W. Lane, Hydropathy, or the Natural System of Medical Treatment (1857); R. J. Lane, Life at the Water Cure (1851); Shew, Hydropathic Family Physician (1857); Smedley, Practical Hydropathy (1879); Smethurst, Hydrotherapia, or the Water Cure (1843); Wainwright, Inquiry into the Nature and Use of Baths (1737); Weiss, Handbook of Hydropathy (1844); Wilson Principles and Practice of the Cold Watet Cure (1854) and The Water Cure (1859). A useful recent work dealing comprehensively with the subject is Richard Metcalfes Rise and Progress of Hydropathy (1906).