THE AIR BATH. BY GERALD B. WEBB, M.D., COLORADO SPRINGS, COLORADO. The air bath, like so many other procedures in medicine, was first introduced by a layman-Benjamin Franklin. O. W. Holmes reminds us of many such debts. "Medicine learned from a monk how to use antimony, from a Jesuit how to cure ague, from a friar how to cut for stone, from a soldier how to treat gout, from a sailor how to keep off scurvy, from a postmaster how to sound the Eustachian tube, from a dairy maid how to prevent small-pox, and from an old market-woman how to catch the itch insect." We can add incidents to this list, such as the invention of the laryngoscope by a Spanish singing teacher in London. In 1750 Franklin wrote to a medical friend as follows: "You know the cold bath has long been in vogue here (London) as a tonic, but the shock of the cold water has always appeared to me as too violent, and I have found it much more agreeable to my constitution to bathe in another element, I mean cold air. With this in view I rise almost every morning and sit in my chamber without any clothes whatever, half an hour or an hour, according to the sea- son, either reading or writing. This air bath is not disagreeable in the least, but indeed most agreeable; and if later I slide into my bed, before dressing, as I sometimes do, I sleep again for two hours as delightfully as one can imagine. I find no bad consequences from this habit and I am convinced there is no prejudicial effect to my health, but on the contrary the air bath helps me to maintain it. I would wish therefore, in future, to recommend the air bath as strengthening and enjoyable." Another layman, Walt Whitman, also employed air bathing. "In 1873 he had a stroke of paralysis (left hemiplegia), and for three years there seemed little promise of recovery. The return to health was slow and incomplete. In those years he spent much time 11 12 GERALD B. VWEBB bathing, or naked in the open air-'hanging clothes on a rail near by, keeping old broad-brim straw on head and easy shoes on feet'-and considered that that counted for much in his restoration to health. 'Perhaps,' he adds, 'he or she to whom the free exhilarating ecstasy of nakedness in nature has never been eligible, has not known what purity really is-nor what faith or art or health really is." In 1777 Boswell observed to Johnson that Lord Monboddo had told him that he awaked every morning at four, and then for his health got up and walked in his room naked, with the window open, which he called taking "an air bath"; after which he went to bed again and slept two hours more. Johnson replied; "I suppose, sir, there is no more in it than this, he wakes at four, and cannot sleep till he chills himself, and makes the warmth of the bed a grateful sensation." Laennec was probably the first physician who indulged in air bathing himself, finding it of benefit to his asthma and no doubt to his acrimonious sweats. It is evident that the priority for air bathing must be given Franklin in view of his letter to Dr. Dubourg in 1750, and in the French literature we find it referred to as "le bain a la Franklin." In searching the literature the air bath is apt to be described with the sun bath, so that some of the physiological changes noted may be in part due to sun effect. My purpose in presenting this paper has been to emphasize the value of the air bath apart from heliotherapy, or heliosis, which was the Greek designation for sun bathing. Leonard Hill reminds us that Darwin observed in Tierra del Fuego that the women and children were quite naked with sleet falling and melting on them. The men wore only a small otter skin laced around the chest. Lahman in 1898 was studying the hygiene of clothes and insti- tuting reforms which are still so badly needed, especially for men, when the idea of air bathing took possession of him. He pointed out that homo sapiens is not amphibious but an air animal. Lahman recalled the observations of Nansen in regard to the Eskimos of Greenland. They found that the skin could not properly function under their heavy garments and so daily would take air baths in THE AIR BATH 13 their tents. As Nansen's illustrations suggest, there was no false shame among these primitive people, the young women and children taking their air baths with the men. Lahman points out that the poison of sweat is five times greater than that of the urine and that death soon occurs in men who have been varnished. Man is almost a naked animal at birth, yet the human foetus during the sixth month is covered with a fine wool- like hair--the lanugo-which according to Darwin is a rudimental representative of our ancestors' coat of hair. Atrophy comes with disuse, and the wearing of clothes for thousands of generations is resulting in a rudimentary condition of the skin. Teeth are integu- mentary in origin and we are as a result of lessening need for masti- cation "casting them in fours along the corridors of time." All writers claim beneficial and physiological reactions from the air bath. Lenkei in 1906 studied these reactions, and found they depended to a certain degree on the air temperature, the atmos- pheric moisture, the radiation and the wind movement. He describes the effects from the tepid, 20° to 30° C., the cool 14° to 20° C., and the cold air bath, 14° C. and under. In general he found the respiration slower but the depth increased, the blood pressure slightly increased, and the pulse slower. After a series of air baths the red corpuscles increased some 7 %, the haemoglobin increased from 13 % to 20%, the white corpuscles increased 10%, and the viscosity of the blood increased. Lenkei found the skin became hyperaemic, bowel activity and appetite improved, and a general sense of well being developed. Grabley in 1908 made similar observations and found the red cells and haemoglobin increased more than after iron and arsenic medication. He claimed the nerve endings in the skin develop and act as a better protective organ for the body. Grabley found a fractional increase in the body temperature, whereas Lenkei noted a fractional decrease. Determan found that the skin reacts to the air bath with an increase in the blood supply, that there was an increase in heat pro- duction in the muscles and an increase in metabolism. He advocated the room air bath in winter and advised the use of the air bath for neurasthenia, headache, insomnia, Graves disease, and chest diseases. Determan urged great care in- prescribing the air bath 14 GERALD B. WEBB for kidney disease, serious heart disease and rheumatism, but mild air bathing could be indulged in with benefit in mild heart cases and in arteriosclerosis. Those who have tried both air and cold water baths will agree with Franklin that the former is equally refreshing and far more gentle. With increase in humidity air baths are less pleasant than when the atmosphere is dry as it is in Colorado. The explanation lies in the fact that water has four times the heat conduction power of air, and by reason of its increase in density water absorbs much more heat. Air baths can therefore be taken for longer periods and at lower temperatures in a dry than in a humid climate. Rikli of Lausanne enjoyed air bathing out of doors in the snow, and Mont- euuis relates that a Russian patient took air baths of ten minutes each morning, on her balcony, where the thermometer stood at ten degrees below zero. The technic of air bathing is quite simple- beginning with a few minutes indoors each morning the period can be gradually lengthened. In winter the windows may be closed at first, but opened more and more as the bather becomes accustomed to conditions. Bed patients with fever can begin air bathing by removing the covers from the feet to the waist, lying on the back and drawing up the legs. This can be done for a minute for the first bath at almost any time of the year. The period can be gradually lengthened each day or several times a day and more of the body exposed. Should the feet be cold a hot water bag can be applied to them. During the past winter one of my patients averaged two or three hours of air bathing daily on an open sheltered porch, with great benefit to health. On stormy days six or more hours have been similarly spent in a well-ventilated room. Such baths are taken in the shade, and there is no doubt that some of the benefit derived from sun bathing is attributable to the concomitant air bathing. Many patients will find the depression of the morning disappear as they become accustomed to the air bath. Rollier confirmed the observation of Herodotus that the muscles developed under sun bathing, but Gauvain believes that the increased musculature is entirely due to the air bath. When the sun is obscured by clouds and when the air bath is taken in the shade a small amount of the ultra-violet rays are received by the body, but THE AIR BATH 15 as far as I have observed no pigmentation of the skin has resulted. Rollier employs air baths beginning in a room with open windows as a preliminary to the sun bathing. Edgar Mayer reviews much of the literature pertaining to the air bath in his excellent work on the Clinical Application of Sunlight and Artificial Radiation. C. F. Gardiner, a member of this society, presented a paper before you in 1Q15 on Dry Air Baths in Treating Tuberculosis and described an apparatus he had devised with an electric fan driving air through screens so that the temperature and force of air could be regulated. Simple methods of treatment are so often at hand when we are seeking the complicated. The addition of the simple air bath to the daily regime of patients with chronic disease lessens the weariness of the prolonged rest, increases the metabolism, relieves at times digestive difficulties and insomnia, and greatly adds to the happiness and the contentment of the patient.

DISCUSSION. DR. ESTES NICHOLS, Portland, Me.: I was surprised that Dr. Webb didn't refer to the experiment of Joe Knowles, who lived in the open without any clothes to see whether he could live. The most striking part of that experi- ment was that when he trapped a bear he was able to kill that bear without a stone. The demonstration was disputed by various newspaper men, who said that it was impossible, but he showed the bear in Portland, and I wouldn't have wanted to get near it. It did prove one thing-that it did increase muscular strength. DR. GERALD B. WEBB, Colorado Springs (closing): In conclusion I only want to apologize for the simplicity of my paper. It was a sad day when Adam and Eve got to use fig leaves and then putting skins on their bodies. It was shown by Nansen that the survival of the Eskimo race was due to skin bathing, while those who didn't adopt the air bathing gave up their health. There is one thing to point out, and that is the extreme atrophy of our skin from wearing clothes.