HYDROTHERAPY

The use of water in the treatment of diseaseHydrotherapy of one kind or another is as old as the history of medicine, dating back to Hippocratic times. Today it is only occasionally used in psychiatry, and then only as an aid or adjuvant in the treatment of such disorders as delirium, involutional psychotic depression and hypochondriasis— particularly when the patient cannot take medications. There are two major types. First, the continuous tub, or prolonged neutral bath, which is given for a minimum of an hour. The patient lies in a canvas hammock in an oversized tub, with his head supported by pillows. The water is continually circulated and kept 1 to 3 degrees below body temperature. The treatment is given primarily to control major excitement, tension, and apprehension, but is terminated if the patient becomes agitated or develops dermatitis, fever, or circulatory disorder.Second, the cold pack, or wet sheet pack. Here the patient is wrapped loosely in layers of sheets and blankets which have been wrung out in cold water. A temperature of 48° F is used for vigorous patients, 60° to 70° for the average patient, and 92° to 97° for those who are frail and cold-sensitive. The treatment is never used as a punishment, nor with patients who do not accept it, and is most effective with the young and robust. When first applied, the sudden cold produces a “therapeutic shock,” which helps to induce a sedative effect. This effect usually sets in within ten to twenty minutes, but may be delayed if the patient is extremely excited. Sedation may be increased by applying ice packs to the back of the neck, and hot packs to the feet. The treatment is terminated if the sedative effect is not obtained within forty-five minutes, or if the patient shows symptoms of “superheating”: rapid pulse, talkativeness, restlessness, flushed face, perspiration. The procedure is contraindicated for aged and emaciated patients, and for those suffering from heart, respiratory, or hyperthyroid disorders.Other types of hydrotherapy include: hot foot baths for sedation; jet sprays and Scotch douches for their tonic and stimulating effect; and the electric-cabinet bath for reducing agitation and feelings of guilt in depressed patients. A recent innovation is the use of swimming pools and aquatic recreation in mental hospitals.