What is a Douche?
A douche is defined as a single or multiple column of water at varying temperature, pressure and mass, directed against some portion of the body. The pressure varies from ten to sixty pounds, depending on the height of the reservoir or source of supply. The mass varies from a "filiform" douche of extreme fineness to a column of water an inch in diameter. The column may be in the form of a jet, fan, filiform rain or shower, and its direction may be horizontal, vertical, multiple circular or ascending.
The Cold Douche
Temperature 55 to 70 degree F. It is only given for a few seconds and at a fairly high pressure. It usually follows some bath of a heating nature and the cold douche is employed to bring about a reaction. It combines the effect of sudden cold with that of a mechanical impact. It is therefore much more stimulating than a cold bath.
Its use is that of a general tonic and stimulant and to induce a reaction. It should not be used where there is active inflammation, in arteriosclerosis, kidney disease and painful affections of the nerves.
The Hot Douche
The average temperature of a hot douche is round about 110 to 115 degrees F. It should begin at 100 and gradually work up to the required degree. In using very hot water the stream must be kept in constant motion otherwise there is a risk of scalding the patient.
Its effects are similar to those of a hot bath with the addition of the mechanical factor in the shape of percussion. It is very exciting to begin with, but later it is relaxing and depressing. It is extensively employed for the relief of pain in neuralgic and chronic inflammatory conditions.
The power of relieving pain seems to be one of the specific properties of heat. This is probably brought about by its effect on the circulation. Every one knows the soothing effect of a properly applied linseed poultice in most painful conditions. To obtain the best results the application must be as hot as can be borne.
It is also of value in relieving the intolerable itching in some forms of skin disease.
The Neutral Douche
This is given at a temperature of between 92 and 97 degrees F. It acts as a general sedative and has a greater influence on the blood vessels of the skin than a bath of the same temperature. It produces no reaction and has its chief uses in insomnia and nervous excitement.
The Scotch or Alternating Douche
This is carried out by the use of two hose pipes, one delivering very cold water and the other very hot. The cold application lasts a few seconds and the hot a few minutes. A rain or shower bath should precede the application in order to thoroughly warm the skin.
The hot application dilates the blood vessels of the skin while the cold contracts them. The cold slows the heart. The alternate contraction and dilatation of the superficial blood-vessels assists in the removal of old inflammatory deposits. It is extensively employed in cases needing general tonic treatment and also in the later stages of muscular rheumatism, and sciatica. It is a valuable application in sprains of joints, especially in the later stages, where there is thickening around the tendon sheaths.
The Rain or Shower Bath
The cold shower bath is generally employed after a hot bath to tone up the skin and induce a reaction.
A hot shower bath is used as a prelude to massage in order to warm up the skin and make it more supple.
Its general applications are very much those of the cold or warm douche to which reference has already been made. The chief difference lies in the direction of the stream which in this case descends from above.
The Needle Bath
This is a circular douche with numerous streams of fine jets directed on the surface of the body. Its effects are very much those of the douches described above, with the addition of the stimulation of the skin by means of the fine streams of water under pressure. It is largely used in combination with other baths for its tonic effects.
Aix Massage Douche
After a preliminary rain or shower bath at a temperature of about 98 degrees F, the patient is seated in a chair and the whole body and limbs massaged under a stream of water at a temperature of about 98 degrees F. Usually two attendants are employed, one to manipulate the hose pipe and the other to perform the massage.
After the whole body has been systematically treated, a strong douche is applied to the front and back of the patient beginning with a temperature of 96 deg. and finishing at 60 degrees F.
Vichy Massage Douche
After a preliminary shower bath at 98 degrees F for a few minutes, the patient lies on his back on an air cushion placed on a table. Instead of a hose pipe as in the Aix system, the water, at a temperature of 98 deg., is conveyed through three or four rose jets suspended above the table. The water is thus broken up into a number of extremely small fine streams very similar to those of a needle bath. Under these fine sprays the patient is thoroughly massaged.
The main difference between the two systems is that in the Aix system the patient is sitting up and the water directed in a single column, while in the Vichy bath the patient is lying down and the water is divided up into exceedingly fine jets.
The effects of a massage douche are practically those of a neutral douche with massage superadded. It is a distinctly sedative measure. At a higher temperature it is stimulating and eventually exhausting. The massage is not so tiring to the patient as a dry manipulation. It is one of the most valuable of balneological treatments and has a most extensive use in cases of obesity, chronic rheumatism, and painful conditions of the fibrous tissues immediately under the skin. It is most valuable in the late stages of sciatica as a means of restoring the lost tone of the muscles.
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