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Physiotherapy in Arthritis: Hydrotherapy
Medical Clinics oj North America November, 1937. New York Num/Jpr
CLINIC OF DR. NORMAN EDWIN TITUS BEEKMAN STREET HOSPITAL PHYSIOTHERAPY IN ARTHRITIS: HYDROTHERAPY
HYDROTHERAPY is a comforting and widely accessible form of conductive heat t~at has been used for the pains in arthritis since years before anything was known about the disease. Cures or spas, where hydrotherapy was the main form of treatment, have been relief-giving and utilized all over Europe since the time of the Romans. Mysterious powers have been claimed for different waters and it is barely possible that some of them, due to what is now known to be radio-activity, produce more effect than bland waters containing varying amounts of salts. The spas frequented by rheumatic patients depend largely upon their salt -content for their accredited, varied effects. We know that these baths at European spas, combined with the regular regime, are beneficial for many cases of arthritis but it is a question what percentage of this benefit is derived from the water itself. In the United States our few well-known cures, such as Hot Springs in Virginia, Hot Springs in Arkansas and Saratoga Springs, are too near the telephone for patients to relax completely. When they really wish to take treatment, they prefer to go abroad, both for the trip and the seriousness of the atmosphere which makes them live up to the prescribed regime. It is to be regretted that the American cures are more places for social gatherings than serious medical treatment. Some .of the cures combine their water baths, which may' be included in the term "hydrotherapy," with baths of either radio-active or ordinary mud. These mud baths are generally taken in tubs and are followed by sprays of water to clean it off. Mud from the northern part of Italy is obtained from the 182 7
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NORMAN EDWIN TITUS
bottom of crater lakes and hence has a high content of volcanic ash, and because of its adhesiveness, can be used for mud packs. More radio-activity is accredited to this kind of mud .than to others. Be that as it may, it is a moot question how much benefit is derived from any radio-activity either in mud or water. But this quality has a great sales attraction for the different spas. The hydrotherapy technic used at these cures is immersion for various lengths of time, with or without manipulation. In England it is usual to give exercises to a patient while immersed in the water and under-water douches are administered with the stream directed at the affected joint. Exercises under water undoubtedly are more beneficial than those on land because the limb floats and less muscular effort is needed. This has been brought out since attention has been directed to hydrogymnastics for the treatment of the paralytic. A great deal of work is being done on paralytics and it is hoped that eventually it will come about in this country that arthritics receive the benefit of hydrogymnastics. This kind of exercise in warm water helps to relieve the pain due to muscle spasticity. For the treatment of arthritis of the joints of the feet, ankle, hand and wrist, the whirlpool bath is particularly sedative. The original whirlpool bath was designed during the World War. In this, water was forced through a nozzle under pressure into a cylindrical tank and air was sucked in with it, making a strong stream of bubbles and giving a very delicate massage. Agitated water can be tolerated by the patient at a higher temperature than if it were still. The whirlpool bath also has been found to cause a more prolonged' hyperemia of an extremity than any other method, including electrical treatments. The whirlpool bath, hydrogymnastics and the under-water douche without air are applicable for direct effect on specific joints. They are combined, as is being done by Currence in New York. He uses a tank for hydrogymnastics and with the Titus whirlpool agitator directs a stream of water toward the affected joint while exercises are given. Arthritis is a constitutional as well as local condition and constitutional effects are easily obtained by all forms of hydrotherapy. Not only the general immersion baths are employed but patients frequently are put in foam or bubble baths. A
PHYSIOTHERAPY IN ARTHRITIS: HYDROTHERAPY
r829
foam bath, as the name implies, is a tub full of foam. This is generated by mixing a few drachms of a saponin solution with about 3 inches of water in the bottom of a tub. A long frame with perforated tubes in it is immersed in this water and air or oxygen are forced through this mixture to form the foam. With this apparatus a tub can be filled with foam in from ten to fifteen minutes. The patient then gets into the tub and is completely covered by the foam, which restricts the radiation of the heat from the entire body. The foam itself is also hot and great perspiration is induced with the natural elimination of toxins. These baths have a very sedative effect upon patients, especially if they are of the nervous type. With the same rack placed in an ordinary bath tub filled with water, air can be forced up through the water, giving a general massage with small bubbles to a patient's entire body. These bubbles may be of ordinary air from a pump, carbon dioxide or oxygen from tanks. Hydrotherapy as an adjunct to the treatment of arthritis has the great disadvantage that it cannot be given conveniently in a doctor's office or in a patient's home. It requires hospital equipment and a real department in which everything is available, as well as hydrotherapy. Hydrogymnastics should be preceded by applications of conversive heat, either radiant or electrical, and tonic baths are best accompanied by ultraviolet light baths. Massage in or out of water should also be given. The use of a single modality in physical therapy is not rational treatment and hydrotherapy, through stimulation of the circulation, is more symptomatic than anything else.
CLINIC OF DR. NORMAN EDWIN TITUS BEEKMAN STREET HOSPITAL PHYSIOTHERAPY IN ARTHRITIS: HYDROTHERAPY
HYDROTHERAPY is a comforting and widely accessible form of conductive heat t~at has been used for the pains in arthritis since years before anything was known about the disease. Cures or spas, where hydrotherapy was the main form of treatment, have been relief-giving and utilized all over Europe since the time of the Romans. Mysterious powers have been claimed for different waters and it is barely possible that some of them, due to what is now known to be radio-activity, produce more effect than bland waters containing varying amounts of salts. The spas frequented by rheumatic patients depend largely upon their salt -content for their accredited, varied effects. We know that these baths at European spas, combined with the regular regime, are beneficial for many cases of arthritis but it is a question what percentage of this benefit is derived from the water itself. In the United States our few well-known cures, such as Hot Springs in Virginia, Hot Springs in Arkansas and Saratoga Springs, are too near the telephone for patients to relax completely. When they really wish to take treatment, they prefer to go abroad, both for the trip and the seriousness of the atmosphere which makes them live up to the prescribed regime. It is to be regretted that the American cures are more places for social gatherings than serious medical treatment. Some .of the cures combine their water baths, which may' be included in the term "hydrotherapy," with baths of either radio-active or ordinary mud. These mud baths are generally taken in tubs and are followed by sprays of water to clean it off. Mud from the northern part of Italy is obtained from the 182 7
1828
NORMAN EDWIN TITUS
bottom of crater lakes and hence has a high content of volcanic ash, and because of its adhesiveness, can be used for mud packs. More radio-activity is accredited to this kind of mud .than to others. Be that as it may, it is a moot question how much benefit is derived from any radio-activity either in mud or water. But this quality has a great sales attraction for the different spas. The hydrotherapy technic used at these cures is immersion for various lengths of time, with or without manipulation. In England it is usual to give exercises to a patient while immersed in the water and under-water douches are administered with the stream directed at the affected joint. Exercises under water undoubtedly are more beneficial than those on land because the limb floats and less muscular effort is needed. This has been brought out since attention has been directed to hydrogymnastics for the treatment of the paralytic. A great deal of work is being done on paralytics and it is hoped that eventually it will come about in this country that arthritics receive the benefit of hydrogymnastics. This kind of exercise in warm water helps to relieve the pain due to muscle spasticity. For the treatment of arthritis of the joints of the feet, ankle, hand and wrist, the whirlpool bath is particularly sedative. The original whirlpool bath was designed during the World War. In this, water was forced through a nozzle under pressure into a cylindrical tank and air was sucked in with it, making a strong stream of bubbles and giving a very delicate massage. Agitated water can be tolerated by the patient at a higher temperature than if it were still. The whirlpool bath also has been found to cause a more prolonged' hyperemia of an extremity than any other method, including electrical treatments. The whirlpool bath, hydrogymnastics and the under-water douche without air are applicable for direct effect on specific joints. They are combined, as is being done by Currence in New York. He uses a tank for hydrogymnastics and with the Titus whirlpool agitator directs a stream of water toward the affected joint while exercises are given. Arthritis is a constitutional as well as local condition and constitutional effects are easily obtained by all forms of hydrotherapy. Not only the general immersion baths are employed but patients frequently are put in foam or bubble baths. A
PHYSIOTHERAPY IN ARTHRITIS: HYDROTHERAPY
r829
foam bath, as the name implies, is a tub full of foam. This is generated by mixing a few drachms of a saponin solution with about 3 inches of water in the bottom of a tub. A long frame with perforated tubes in it is immersed in this water and air or oxygen are forced through this mixture to form the foam. With this apparatus a tub can be filled with foam in from ten to fifteen minutes. The patient then gets into the tub and is completely covered by the foam, which restricts the radiation of the heat from the entire body. The foam itself is also hot and great perspiration is induced with the natural elimination of toxins. These baths have a very sedative effect upon patients, especially if they are of the nervous type. With the same rack placed in an ordinary bath tub filled with water, air can be forced up through the water, giving a general massage with small bubbles to a patient's entire body. These bubbles may be of ordinary air from a pump, carbon dioxide or oxygen from tanks. Hydrotherapy as an adjunct to the treatment of arthritis has the great disadvantage that it cannot be given conveniently in a doctor's office or in a patient's home. It requires hospital equipment and a real department in which everything is available, as well as hydrotherapy. Hydrogymnastics should be preceded by applications of conversive heat, either radiant or electrical, and tonic baths are best accompanied by ultraviolet light baths. Massage in or out of water should also be given. The use of a single modality in physical therapy is not rational treatment and hydrotherapy, through stimulation of the circulation, is more symptomatic than anything else.