Topical Diaphoretics.

Caloric.

Heat properly applied to the surface of the body is not only an important auxiliary ageut to the use of diaphoretic remedies, in the production of perspiration, but it is also one of the most powerful single measures in the hands of the physician of producing determination to the surface, relaxation of the skin, and sweating.

Either dry or moist heat, if applied to the surface at a temperature exceeding that of the body, acts as a general excitant, increasing the fullness and frequency of the pulse, the heat of the surface, and its secretion. If applied to the surface a few degrees below that of the body, it exerts a soothing and relaxing influence upon the cutaneous tissue, lessening exalted capillary action in the vessels of the surface, removes constriction, and strongly disposes to perspiration.

Warm Air.

Air, when heated to the temperature of from 85° to 100°, and brought in contact with the surface of the body by placing a burning lamp under the chair upon which the patient is seated, surrounding the body with a blanket, the head being uncovered, or by conducting the heated air through a tube under the bed-cover, thus bringing it in contact with the body, exerts a gentle excitant influence on the cutaneous tissue, and occasions copious perspiration. It seems to exert a soothing, tranquilizing influence on the nervous system, and in this way also predisposes to diaphoresis. It is said by Dr. A. T. Thompson, to surpass either the warm water or vapor-bath, for certainty of producing sweating. The warm-air bath has been found beneficial in chronic, deep-seated neuralgia, in rheumatism, both acute and chronic, in the early stages of febrile and inflammatory diseases, chronic cutaneous diseases, etc. By elevating the temperature, it becomes excitant, and may be used in violent spasmodic action, internal congestions, etc. Its diaphoretic effects will be much aided by using some mild, warm, diaphoretic infusion, one or two doses of the Sudorific Tincture, or, when sweating has commenced, by copious draughts of cold water.

Alcoholic Vapor Bath.

This is very similar to the warm air bath, consisting principally in the application of hot air to the surface, very little vapor being generated by burning alcohol. The vapor or heat of burning alcohol, or some dilute alcoholic liquid, may be applied to the surface in a similar manner to the application of hot air. The most common way of employing it is to place the patient in a wood-seat chair, place his feet in a bucket of hot water, and surround him with a blanket, so as to keep in the heat. Then take a shallow vessel, as a saucer or plate, pouring it part full of alcohol, diluted so that the flame will not rise high enough to burn the patient, slip it under the chair, and light it with a match or piece of paper. During the time of taking the bath, the patient should take some diaphoretic internally, as the sudorific tincture, diaphoretic powder, or some warm diaphoretic infusion. This process may be contiuued from ten to thirty minutes, according to the vigor of the constitution, the effect produced, or the intractable character of the disease. If the patient can not sit up, the vapor may be conducted under the cover, by raising it from the side of the bed with a chair, and supporting it over the patient—the burning alcohol being set by the side of the bed, and so surrounded that the vapor can not escape.

Of all the measures to which we have resorted for the production of diaphoresis, the burning alcohol is the most efficient, if aided by the internal use of warm diaphoretic drinks. We care not how high the grade of inflammatory action, or how intense the fever, it will cause a copious perspiration, with a reduction of organic action, mitigation of the pain, heat of surface, and nervous disturbance, in a very short time. In cases attended with pungent heat of the surface, a dry or husky state of the skin, with a full and bounding pulse, great restlessness, and intense febrile or inflammatory action, it is much better to premise with cold ablutions for twenty or thirty minutes, before resorting to the use of the vapor bath. In acute or inflammatory rheumatism,and also in the chronic form of the disease, we know of no remedy of equal utility. It is much more stimulating to the surface than the aqueous vapor bath, even when both are applied at the same temperature, and hence is better calculated to relieve internal congestions. In sudden cold, suppressed perspiration, acute local inflammations—as pneumonia, pleuritis, hepatitis, enteritis, nephritis, etc.— in spasmodic action, violent painful affections, etc., it seems to relax the whole system, lessen organic action and the erythism of the nervous system, and induces copious perspiration. The advantages thus gained over diseased action, if maintained by other appropriate medication, can not fail, in thousands of instances, to put a speedy stop to the most formidable diseases in a few hours, without the use of the lancet, calomel, or tartar emetic.

It is obvious that this energetic course, and the production of such free and continued perspiration, would be highly detrimental, or even fatal to the patient, in the advanced stages of acute or chronic diseases, if great debility exists.

Warm Vapor Bath.

This bath occupies an intermediate position between the warm air bath and the warm water bath. Vapor, to produce similar effects, requires a higher temperature than warm water, and not so high as warm air.

This may be applied by seating the patient on a chair over a kettle of boiling water, surrounding him loosely with a blanket, to prevent the escape of the vapor, and putting hot bricks, stones, etc., in the water, to keep up sufficient heat; or it may be applied by enveloping the patient in a blanket kept at some distance from the body, within which the vapor may be conducted by a tube leading from a closed vessel kept boiling by means of a spirit lamp; or the vapor may be conducted under the cover of the bed.

What is termed the Medicated Vapor Bath consists in impregnating the vapor with certain medicinal agents which may be supposed to exert a beneficial influence in removing the existing disease. The agent or agents used in this case are formed into a decoction, the vapor of which is used, or they are dissolved in the water used for the bath. Camphor, sulphur, and various gases, have been used in many cases as independent remedial agents in the form of a vapor bath.

As a therapeutic agent, warm vapor applied to the surface serves to soften and relax the cutaneous tissue, gently excite the capillary circulation of the surface, and produce copious sweating. It is more soothing and relaxing than the warm air hath, and possessed of greater power as a sudorific. It is employed in colds, sudden check of perspiration, and in the early stages of febrile and inflammatory excitement, when the surface is dry and constricted, with pain, restlessness, oppression, etc., either as principal or auxiliary means of producing perspiration. In almost every variety of febrile or inflammatory attack, it may be resorted to with a prospect of advantage, and also in many forms of chronic inflammation, rheumatism, and in many chronic cutaneous diseases. It has also been used with much advantage in amenorrhoea, dependent upon subacute inflammation of the uterus, especially when accompanied with a dry and harsh skin, and want of perspiration.

Topical or Local Vapor Baths are useful in local diseases, as painful inflammatory affections of the joints, rheumatism, gout, neuralgia, painful swellings, tumors, etc., and as an anodyne and soothing application to painful wounds, contusions, fractures, etc.

The vapor douche consists in directing a jet of aqueous vapor upon a particular part; it is really a topical vapor bath. It is employed in otalgia, otitis, otorrhoea, etc., by introducing the vapor into the ear through the orifice of a funnel inserted over a vessel of hot water. It may be applied to the genital organs, neck of the uterus, etc., in dysmenorrhoea, painful irritation or inflammation of the neck of the uterus or vagina, and likewise in many other painful local affections.

Warm Water Bath.

The tepid bath consists in the immersion of the body in warm water at a temperature varying from 75° to 90°. It serves to cleanse the surface, equalize the circulation, allay thirst, relax the cutaneous emunctories, promote diaphoresis, and lessen organic action and the temperature of the body. It seems to act rather as a refrigerant and sedative, as is manifested by the languor, loss of muscular power, faintness, and somnolency, which soon follow the transitory excitement at first produced.

It is sometimes used in some of the acute phlegmasia, after other measures, but it is not to be relied on in the production of diaphoresis. When elevated to a higher temperature, or what may be termed a hot bath, it then becomes excitant, and proves serviceable in relieving congestions of internal organs, and in promoting the eruptive process in some of the exanthemata. The warm water bath is employed in chronic inflammations, spasmodic and convulsive diseases of children, amenorrhoea, dysmenorrhoea, etc.

The Coxeluvium, Semicupium, or Hip Bath, is employed in inflammatory or spasmodic affections of the pelvic viscera, amenorrhoea, dysmenorrhoea, spasm of the ureters or urethra, as in the irritation caused by the passage of urinary calculi, etc. It may aid indirectly in the production of diaphoresis, but it can not be depended on for this purpose.

The warm Pediluvium, or Foot Bath, favors diaphoresis by equalizing the circulation, lessening exalted action, and relaxing cutaneous constriction through a sympathetic influence. It is one of the most valuable adjuncts to internal diaphoretics, and as it is easily used, it is a favorite remedy both in domestic and professional practice.

Fomentations and Poultices act as topical baths, owing to the warmth and moisture which they contain. They thus serve to soften and relax the parts to which they are applied, and exert a sympathetic influence upon the entire system, which may result in diaphoresis.

Cold or Tepid Ablutions.

Cold or tepid ablutions, although they exert no direct agency when applied to the surface, in the production of perspiration, yet their indirect influence, in many instances, is of great importance. They act as refrigerants and sedatives; even if the ablution is tepid, the speedy evaporation which follows carries off the heat of the surface, and lessens capillary activity and even general vascular excitement, rendering them refrigerant and sedative.

Cold affusions, the cold douche, or cold immersion, all act in the same indirect manner in promoting perspiration. Their free and frequent application to the surface when it is hot, dry and constricted, and when accompanied by intense febrile and inflammatory excitement, serves to lessen the undue vascular excitement, cool and relax the skin, and promote diaphoresis. Their action, though indirect, is none the less important, and should never be overlooked by the physician in the cases referred to, as they are among the most powerful auxiliary measures to which he can resort to reduce exalted vital action, and induce perspiration. (See Refrigerants.)

Cold Wet-sheet Pack.

This is one of the most powerful means of inducing diaphoresis with which we are acquainted. It is especially applicable in febrile and inflammatory diseases, as well as in some chronic affections. In high grades of fever, when the skin is hot, dry, and constricted, its use is pleasant to the patient, cooling the surface, relaxing the skin, subduing nervous irritation, and producing profuse sweating. The personal experience of a physician may illustrate its use and action. Some years ago he caught a severe cold from exposure, perspiration was entirely checked, and he had alternate chills and flushes of fever. There was also such a degree of pain in the back and limbs, and general nervous irritability, that he could not sleep for two nights preceding. He made up his mind that as he did not like to be sick, and had an aversion to swallowing his own medicine, he would take the wet-sheet pack. (Family opposed, said it would be certain to kill him.) The sheet was wrung out of cold water, and laid upon a blanket which covered the bed, and upon this our doctor got, and it was well tucked in around him, putting as many extra blankets above as he could well bear. For the first five minutes it was one continued chill, shaking as badly as ever man did with the ague; but after this it soon grew pleasant, the pain ceased, and in less than fifteen minutes he was sound asleep, and slept comfortably for two hours, the first he had had for two days. Upon awaking he was in a profuse perspiration, and was told he had been so since he went to sleep, and what was better, the disease had entirely left him, and did not re-appear.

We have tried this means of producing diaphoresis in many cases, such as has been named, and always with the most beneficial effects; we would, therefore, strongly recommend it to the notice of the profession. Objections are frequently made to its use by patients, who can not understand why we should wish to put them in cold water, when probably the disease originated from what they supposed a somewhat similar exposure. These objections, however, are removed after one or two in a community have experienced its beneficial effects.

Hot Blanket Pack.

When the circulation is feeble, a blanket may be wrung out of hot water and applied as the ordinary wet-sheet pack. It is especially indicated when the temperature is low, and the skin atonic.

Hot Sponge Bath.

In the same conditions we employ water as hot as it can be borne, by sponging the surface rapidly. A small part should be taken at a time, rapidly dried, and covered with flannel.

Friction.

Friction of the surface with a flesh-brush or dry flannels, serves to excite the cutaneous exhalants to increased activity, and favors the production of diaphoresis. It is usually employed with ablutions and baths, as an additional measure, and not as an independent therapeutic agent. It will be found advantageous in many chronic diseases, local dropsies, indolent tumors, chronic swellings, indurations, etc., as a means of producing revulsion.

The American Eclectic Materia Medica and Therapeutics, 1898, was written by John M. Scudder, M.D.