in non-malignant growths. The radium rays do not penetrate as deeply as do the roentgen rays, therefore radium is used more successfully for surface conditions and tumors that can be reached, as in the larynx or in the uterus. Tubes containing radium are sometimes imbedded in the tumor growth so that it will act throughout the tissues of the tumor. As with the roentgen ray, too small a dose may stimulate growth, while a larger dose will destroy the pathogenic tissue.

When the radium treatment is energetically given, especially to the uterus, it must be understood, as pointed out by Graves,1 that very unpleasant symptoms may occur. There may be nausea, bleeding, severe pain, and much other general nervous disturbance. Consequently, a patient must be under special supervision in a hospital when this active treatment is given. Later there may be much leucorrhea follow the treatment.

The radium treatment of epithelioma and other growth: the skin, especially those of the horny variety, has been successful. Cohen and Levin2 sum up their radium treatment of cataract by stating that it is harmless to the eye, that it diminishes opacities of the lens, that it does not interfere with later removal of the complete cataract, and they believe that beginning cataract should be treated by this method.

It is hardly necessary to insist that all treatments with radium for the destruction of tissue or for action on the skin and mucous membranes should be undertaken only by an expert.

HYDROTHERAPY

Baths and applications of water were ancient methods of preserving health and of treating disease, as the writings of Hippocrates testify, even cold water bathing for fever being recommended by him. Galen and early Roman physicians used water as a therapeutic measure, but the medical school at Salernum was the only recorded advocate of water treatments during the Middle Ages. Some revival of the use of water therapeutically occurred in the seventeenth and eighteenth centuries, especially in England and Germany, but not much gen

1 New York Medical Journal, June 5, 1920, p. 969.

2 Journal A. M. A., Oct. 18, 1919, p. 1193.

eral interest in this physical treatment developed until, in 1820, Vincent Priesnitz, a farmer of Silesia, began to laud its use for diseased conditions. Professor William Winternitz, of Vienna, has been termed the father of modern hydrotherapy, as he raised this method of treatment to a more scientific basis. Simon Baruch, of New York is the pioneer in this country in urging the great value of this physical means of treating disease.

In Germany, in the last decade of the last century, a Roman priest named Kneipp taught and expounded the value of cold water for all kinds of diseased conditions, and advised both adults and children to walk bare-footed in cold water, or in snow, to prevent disease. This obsession has been copied in various parts of America, both by peculiar cults and by radical specialists in tuberculosis. Kneipp died in 1903.

By hydrotherapy is generally understood the treatment of the whole body by various types of water baths. However, under this heading it has become the custom to describe the applications of hot and cold water, by various methods, to a part of the body for local action on that part. Obviously the physiologic changes occurring from a treatment of the whole body must be different from those that occur when only a small portion of the body is treated. Also, the therapeutic object aimed at in the two instances must be different. Hence the subject of hydrotherapy must be discussed under separate headings.

Balneotherapy. The effect of baths on the body is shown by the effect on the organs and the circulation when heat or cold is applied to the surface of the body. If the body is warmed all over, the surface vessels dilate, the blood-pressure is lowered, and internal congestion is relieved, i.e., the internal organs will be depleted of blood. By hot baths the surface of the body is warmed; the skin is better nourished; peripheral nutrition is improved; nerve rest is caused, perhaps sleep; the kidneys become more active, if the blood-pressure is not too much lowered; and the circulation of the lymph and blood in the muscles is promoted. If the bath is too hot or too long continued anemia of the brain is caused, and faintness.

The reverse of all this occurs from cold baths, namely, the peripheral blood-vessels contract; the internal organs and the

brain are congested; the blood-pressure is raised; the kidneys are stimulated; intestinal peristalsis is increased; and general metabolism is more or less increased. If the cold bath is too intense or too long continued there will occur general depression and impairment of function. The number of corpuscles in the peripheral blood, both red and white, may be greatly modified by the action of hot and cold baths.

It is therefore evident that by hydrotherapeutic measures we can actively modify the circulation and at times the nutrition of all parts of the body. Therefore, these measures when properly directed are potent for good, and when misdirected may do harm.

Heat for Systemic Effect.-Theoretically, the hot bath should not be taken except at bedtime, on account of the relaxation caused and the tendency to produce anemia of the brain and therefore sleep. At other times of day, theoretically, a hot bath should be followed by a cold plunge or cold sponge to again raise the blood-pressure and prevent the feeling of relaxation. However, it is possible that standing in the bathroom while the individual is drying his skin (if the bathroom is not too warm) may, by the effect of the cool air, again raise the blood-pressure. The corollary of this is obvious, namely, that too hot baths should not be taken; that too frequent hot, or even warm, baths should not be allowed; and that the individual should not remain too long in a warm or hot bath. Young girls and young women are especially prone to soaking in hot baths, which causes loss of strength and general debility. The reverse of this is also true, namely, that a patient with high tension, high blood-pressure, and a cool and dry skin is especially benefited by hot baths.

The warm bath, i.e., a heat but a degree or so more than the body temperature, is sedative. Primarily a hot bath causes. some nervous stimulation and may cause temporary irritability of the nervous system, especially if the heat is sufficient to cause a momentary vaso-constriction of the peripheral vessels. As soon as the patient comes out of such a hot bath, especially if he has drunk much water, perspiration will be profuse. This primary peripheral vaso-constriction from a too hot bath may cause a feeling of fullness in the head, which is soon, however,

relieved by the secondary vaso-dilation that occurs. At this time there may be a feeling of faintness. The hot bath will increase the internal temperature, although the temperature may fall later by the profuse perspiration. The perspiration following such a hot bath will cause a large loss of water from the body, and, if the system is not replenished with water, may cause a concentrated urine and constipation. A considerable amount of sodium chloride may also be thus lost through the skin. In hot weather a hot bath is a great relief, as when the individual comes out of the bath, on account of the perspiration and evaporation, he feels much cooler and his temperature is reduced. Also it may be noted that in some countries, notably Japan, the hot bath is in daily use, and those who are used to them are not depressed. This is especially true if too warm clothing is not put on after the bath.

A hot bath, not a warm bath, tends to relieve not only internal congestion, but relaxes spasm and contraction of muscular tubes and relieves muscle cramps. Therefore hot baths are resorted to in the various abdominal colics. Warm baths are sedative in nervous excitement and may be used in chorea and mental excitement.

Hot baths increase metabolism, and if they are taken too frequently, increase tissue waste, and weight may be lost, consequently various forms of hot baths are used to promote loss of weight in the obese.

When there is low blood-pressure, or when there is edema of the legs or general anasarca, hot or warm baths are not indicated; they will do harm. In any serious condition hot baths are not indicated, unless there is high blood-pressure, and then the water should not be warm enough to cause nervous stimulation. In depressed circulation, but with the blood-pressure not very low, warm baths, or the medium bath (a bath just above the body temperature) are beneficial as they increase the peripheral circulation and relieve the internal congestions. In inflammations of the skin hydrotherapeutic measures may be contraindicated, but various demulcent additions may be made to the bath, especially if there is a tendency to irritation or urticaria after bathing. Bran is often added to baths for

such purposes. Ointments or fats are sometimes rubbed on the irritated skin before the bath is taken.

It should be emphasized that uremia is not benefited by hydrotherapeutic measures that cause profuse general sweating. It should be remembered that only water, sodium chloride, and a few other salts, and very little urea, are excreted by even profuse perspiration, and the abstraction of water concentrates the poisons circulating in the blood. Therefore, while a patient may survive such treatment, on account of blood being drawn to the periphery and the kidney congestion being thus relieved they may become able to resume excretion, still the same results may be caused by hot packs to the lumbar region without recourse to such profuse perspirations as endanger the life of the patient. To repeat, it is illogical to concentrate poison in the individual's blood by profuse sweating. Venesection had better be done in these instances, provided the blood-pressure is high. If the blood-pressure is low in advanced cardio-vascular-renal disease, profuse sweating and active purgation are positively contraindicated.

The toxins of infection and the salts of metallic poisons may, by various forms of hot baths, be brought from the internal organs to the peripheral and general circulation and their elimination made more rapid.

Hot applications to the abdomen may be of advantage in relieving cerebral congestion.

Turkish Baths.-The so-called Turkish bath is given by a sojourn of the individual in a series of rooms, with the temperature gradually increasing, even up to 150° F.

The bather, deprived of all clothing, enters the first room in which a turban saturated with cold water should be placed about his head. As soon as he becomes accustomed to the heat of this room he proceeds to the next, and so on, remaining in each room until he does not mind the heat. Ordinarily he should drink several glasses of cold water to aid in promoting perspiration. A feeling of faintness, dyspnea, or of oppression in the chest should cause the bather to immediately go to a cooler room, and a patient should not go into the rooms of high temperatures unless by the advice of a physician. After the