Appendix.

895

has become general and profuse. In cases in which there exists a morbid increaseof bile disturbing the functions of the stomach and irritating the bowels, the tem-perature of the water used as drink may be from 90° to 114°; and in some casesof dyspepsia, which are attended with the sensation of coldness at the stomach, andwith cold extremities, a cup full of water, taken as hot as it can be drank, affordsvery considerable relief. In cases of redundant bile, by drinking half a pint oftepid water every morning before breakfast, and taking immediately afterwardsmoderate exercise, the acrid bile is diluted, and its passage through the bowelsassisted, without the irritation which, in its undiluted state, it always excites;and it produces the same benefit in cholera morbus in the commencemeiA» of thedisease, the stomach being rendered by it more fit to receive opiates and otherremedies. Some medicines, as sudorifics, diuretics, and emetics, scarcely producetheir effects, unless their operation be assisted by copious dilution with water, orwatery fluids.

Water is also an external remedy of great importance, but its effects are muchmodified by the degree of temperature at which it is applied.

Cold Water, or of a temperature under 70°, gives the sensation of cold to theskin, and is applied under the form of bath and of affusion.

The cold Bath, .(balneumfrigidum,) is water of any temperature, from 42° to85° of Fahrenheit. When the body is immersed in it, it first induces the sens-ation of cold, excites shivering, renders the skin pale, and contracts it so as toproduce the papillous appearance denominated goose skin (cutis anserina) ; therespiration at the same time is quickened and rendered irregular, producingsobbing; and the pulse is diminished in force and velocity, but is also renderedfirmer and more regular. If the immersion be not long continued, re-actiontakes place on coming out of the bath, a glow, or agreeable sensation of heat, isfelt over the whole body, the tone and vigour of the muscles are increased, a buoy-ancy of spirit and aptitude for action succeed, and a sense of general refreshmentis experienced by the bather. The protraction, however, of the immersion for aconsiderable space of time, particularly if the temperature of the bath be under50°, is not followed by this re-action, but the cold water operates as a powerfulsedative ; the action of the heart and arteries becomes languid, the pulse ceases atthe wrist, the animal heat is rapidly diminished, and a sensation of coldness atthe stomach is felt, which is succeeded by faintness, delirium, torpor, and some-times death. These unpleasant effects are occasionally experienced in somedegree, even when the immersion is not protracted, and the temperature of thebath is not under 60°; in which case cold bathing proves always hurtful, andought not to be repeated: but when the contrary effects are experienced it isfound to be useful in many diseases of debility, particularly in scrophula, if thewater be impregnated with salt, or sea-bathing be resorted to. The debilitated,however, in whom the use of sea-bathing produces these effects, when it is em-ployed before breakfast, are not always affected in the same manner when it isused after breakfast, or when the stomach is full; but, on the contrary, receivethe same benefit from it as those with whom it agrees at all times. The use ofcold water as a general bath is never employed with a view of producing itssedative effects : but for this purpose it is partially applied, either by the immersionof the affected parts, or by means of cloths dipped in very cold water, and laidover or near the parts. It is used as a remedy in active uterine hajmorrhagies,burns, and scalds, and in local inflammations, even when arising from generaldisease, as gout and acute rheumatism, when the surface of the pained partappears red and inflamed.

The cold affusion, or the suddenly pouring cold water over the whole surfaceof the body, operates as a powerful remedy, although its effects as such are of«hort duration. They are produced by the suddenness of th^ application affectingthe nervous energy, and by the shock rousing the dormant sensibility, so as toinduce a new action, as it were, of the nervous system, dissolving the spasm onthe extreme vessels of the surface, carrying oft' a large portion of morbid heat bygeneral evaporation, and the remainder by insensible perspiration ; thence restor-ing the healthy action of the exhalants and the capillaries. In typhus fever thismode of applying cold water has been productive of the best effects.' It should

1 The cold affusion was employed by Antonius Musa, physician to Augustus,when that emperor was affected with a bowel complaint, which had resisted eyery