Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

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Forms of hydrotherapy, useful in treating mentally ill persons, include the sedative pack (full body pack), a neutral bath or whirlpool, the warm fomentation, or wet sheet pack allowed to warm up to neutral. The latter have given far more satisfactory results than other types of hydrotherapy.

To obtain a stimulating effect, use graduated cold packs—beginning mild and getting colder—followed by cold mitten friction to insure a good reaction. In one mental hospital in Illinois, before the era of tranquilizers, during a 9-year period in which hydrotherapy for mental illness was being constantly developed and extended, an increasing improvement rate with more hospital discharges was experienced. During the first three-year period, the percentage of patients paroled and discharged was 36.2. During the second three-year period, 44.63% were paroled and during the third, 67.63%. Patients treated with hydrotherapy were found to be more comfortable. Fewer were found to be in conflict with others, and fewer in restraints.

The treatment of psychotic patients with either general or local applications of heat while neglecting the use of cold to the head may increase the psychotic symptoms. Dr. Henry Kefauver reports a case of manic depressive psychosis, who was being treated with a continuous neutral bath for 6 hours at 90° to 96°, beginning at 8:00 a.m. At this time, his pulse was 104, and he was restless and talkative. A cold compress was applied to the forehead before the bath. In one hour the pulse rate dropped to 64. At 10:30, the patient became very excited, noisy and unmanageable, breaking through the canvas cover of the tub, and refusing further treatment. At that time the patient was immediately placed in cold wet sheet packs. On investigation, it was learned that the cold compress to the head had been removed when the pulse dropped to 80. The water temperature had been increased, making it then a hot bath, raising the body temperature, and the pulse made a corresponding rise to 124. After the cold wet sheet was applied, the patient received cold to the head again, and the pulse again dropped to 80. At that time, the patient slept nearly an hour in the pack and was removed quiet and cooperative, with pulse rate around 76.

A patient with schizophrenia was given a continuous neutral bath of three hours' length beginning at 96° at 8:00 a.m. The patient was excited, combative, and very noisy at the time of being placed in the tub. A cold compress was applied to the forehead, and an ice cap to the back of the neck after entering the tub. He became quieter in the bath, pulse 66. A noticeable increase in restlessness and talkativeness occurred during the second hour, when it was discovered that the ice cap had become warm and ice entirely melted. The patient's face had not been sponged, and the face was flushed with some perspiration, showing on the upper lip. The pulse was 96 at 10:00 a.m., and the water temperature was 96°. Upon renewal of cold to the head, face and neck, the patient immediately began to feel more comfortable and quiet, his face lost its redness, and perspiration stopped. The patient was removed at 11:00 a.m., much quieter, and with a pulse of 60.

For another schizophrenic patient, catatonic type, the prescriptions included cold mitten friction, salt glows, saline baths, shampoos, needle sprays, and fan douches. The patient did not talk, was non-cooperative, resistive, and antagonistic. The mittens used were made of Turkish towel material and wrung from cold water at 60°. This treatment was continued at regular intervals for about two months, when the patient began to show signs of noticing things and with urging could be gotten out of bed for a short period. At that time, the prescription was changed to tonic baths, salt glows three times a week, saline baths twice weekly at 97° for 30 minutes. He was given body shampoos one day a week. Hot foot baths at 104° to 110° were administered preparatory to the tonic procedures. Cold compresses were applied to the forehead prior to putting the feet in hot water. With the salt glow, the cold compresses to the head were changed after treating each body section. During the saline baths, the cold compresses were changed every ten minutes. After 7 months of treatment, the patient was given an outside parole.