THE DOUCHE 
SIMON BARUCH, M.D., 
Physician to the Manhattan General Hospital, Juvenile Asylum, and Montefiore Home for Chronic Invalids. 
The remarkable therapeutic success attained by the French physicians, chief among whom stands 
Charcot, with this method of utilizing water in many diseases which prove rebellious to medication 
and all other treatment, warrants a brief descriptive explanation of this hydriatric procedure. 
The drawing illustrates the act of douching, the attitude of physician and patient, and the 
apparatus. The douche is a method of applying water, in a more or less concentrated form, in a stream 
propelled by more or less atmospheric pressure. 
The effects aimed at by all hydrotherapeutic procedures are thermic and mechanical. 
The sudden impact of cold or cool water upon the periphery produces a contraction of the 
coats of the cutaneous vessels; the shock thus induced is conveyed to the central nervous system, 
thence by reflex to other organs. 
The gasp for breath illustrates the reflex effect upon the respiratory centre. The blood is 
driven from the surface to the deeper parts, but returns as soon as the douche is discontinued, under the 
physiological law of reaction. This is the aim of the douche-to arouse dormant vital energy by 
inducing reaction in the various parts to which it is applied. 
It is a discipline to the peripheral nerves and vessels which no medicinal agent is capable of 
inducing. The ebb and flow of blood and reflex action aroused by the douche represent in brief its chief 
effect. 
These manifestations are modified according to the temperature and mechanical action. The 
former is under control by admixture from the supply pipe of cold and warm water ; the latter by in- 
creasing or diminishing the atmospheric pressure. Just as the thermometer indicates the temperature 
of a douche so does the pressure gauge indicate the mechanical effect. 
In the accompanying drawing the hot water supply is at II, under control of the valve II; the 
outlet into the hose is at H, II. The cold water supply pipe is at C, under control of the valve. C ; its 
outlet is into the main exit pipe, controlled by the valve at C, II. The water mixes at M. According 
to the opening in the valves the hot and cold currents are admitted and controlled as they are in an 
ordinary bath-tub. 
At R, B, is the supply pipe for the rain-bath. At G is the pressure gauge. W is the waste 
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Reprinted from Illustrated Medicine and Surgery. 
Copyright, 1892, by E. B. TREAT, New York. THE DOUCHE. 
pipe. Through the latter the water is allowed to run until the temperature is adjusted. The manner 
of application is shown in the drawing. 
This represents at J, D the jet douche. This may be changed by attaching the sprinkling 
nozzle to the spray douche, or by applying a fiat piece of metal over the nozzle outlet into a fan 
douche. 
The rain-bath R, B, is a douche driving a large number of jets upon the skin. Their impact 
under a pressure of 20 lbs. is sufficient to dilate the peripheral vessels, illustrating the valuable reactive 
effect of such a bath. 
The therapeutic applications are varied. 
For anaemia and general debility, without organic involvement, with or without gastric 
Douche Room at the Hydriatric Institute, New York. 
trouble, the rain-bath from 65° to 75° is of great value. In the Montefiore Home its chief application 
has been in phthisis. Numerous excellent results are recorded in this institution of restoration to 
apparent health, of cases whose object in coming to the institution was to spend their remaining days 
in comfort. 
Administered daily for two to five minutes, from 65° to 80°, it relieves pyrexia, improves the 
appetite, deepens the respiration, steadies and slows the heart, and refreshes the nervous system, through 
which it gives tone to all the systemic functions. 
In neurasthenia (of the depressed or melancholic type), with or without gastric, cardiac, or other 
manifestations, the jet or fan douche, at 45° to 50°, which promenades over the body for five to 
thirty seconds, under a pressure of 20 to 30 lbs., is a therapeutic agent of approved value. In the 
same type of hysteria also this douche is efficacious, as demonstrated by Charcot. 
202 THE DOUCHE. 
In the erethetic types of these diseases, and in other neuroses, accompanied by manifestations of 
excitement, the douche is inapplicable. In these cases the German method of wet packs are useful. 
In chronic gastric disturbances, accompanied by anaemia or depression, the douche at 60° to 75° 
under a pressure of 20 lbs., for two to four minutes, or the rain-bath, has afforded me good results after 
dietetic and other treatment has failed. 
In simple anaemia or chlorosis, in all organic diseases in which a faulty haematosis is manifested, 
the cold douche has signally demonstrated its value on the haemometer of Fleischl. In obesity, chronic 
gout, and rheumatism, striking curative results have been obtained from hot-air baths (to which the 
head is not exposed) followed by cold general douches. Locally, the Scotch douche, consisting of 
alternating hot and cold streams to the swollen joints, encourages absorption of pathological product. 
In obesity and other disturbances of perverted tissue metamorphosis, this method of diverting the latter 
into normal channels has been clinically and experimentally successful. (See A. Frey in Volkmann's 
Sammlung Klinischer Vortraege.} 
In locomotor ataxia and other spinal or cerebral organic lesions, the cold douche must be 
avoided as a dangerous remedy, while warm and hot douches and rain-baths, under slight pressure-ten 
to 15 lbs., and of long duration (5 to 10 minutes)-will be found useful. The warm bath, judiciously 
applied with friction by an attendant, is far more efficacious in these cases, as shown by Leyden and 
Hoesslein. 
The chief element in this as in all other hydrotherapeutic procedures is precision. Upon this 
depends success, and to its absence may be charged all failures and unreliable results. 
In the douche apparatus here illustrated, three instruments of precision are utilized, the second 
clock, noting duration, the pressure gauge, noting force of impact, and the thermometer, noting tem- 
perature. 
Upon the judgment of the physician depends the selection of the case. That the profession in 
this country has not yet appropriated a therapeutic agent of such great value as water may probably be 
accounted for by the fact that the empirics, having energetically espoused it, have brought it into 
disrepute. 
This brief descriptive article is intended by the author to recall the fact that water is an orthodox 
remedy, upon which Hippocrates wrote an able treatise (he brought out the fact too little regarded in 
this enlightened time even, that cold water excites and stimulates, while warm water soothes and 
depresses), and which enjoys the earnest advocacy of clinicians like Ziemmssen, Semmola, Erb, and 
Charcot. 
Note,-The Douche Room here depicted is built of marble walls, eight feet high, resting upon a slanting floor of 
boards covered with zinc. The lower edges of the wide marble slabs rest within the upturned border of zinc, thus readily 
conducting the water falling from them upon the floor. Upon the latter rest small wooden sleepers, supporting a slatted floor, 
which permits the water flowing from patients at once to fall upon the slanting zinc floor, which conducts it to the drain. 
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