Nature Cure Clinical Pearls: The Knee Gush

Sussanna C. Czeranko, ND, BBE

The cold water-gushes are the means of producing heat and invigorating the whole system.

Benedict Lust, 1900, p. 6

You will find in the works of Kneipp that he repeatedly refers to the knee-douche and states how men, strong, robust, have crouched like children, and have yelled when it was applied. 

Dr. A. Baumgarten, 1904, p. 8

By pouring water on the patient a quicker reaction is brought on than by bathing; pouring was Father Kneipp’s special method.

Dr. Bauergmund, 1908, p. 71

Father Sebastian Kneipp made numerous contributions to the naturopathic profession even though today we have all but forgotten many of them. His story, like that of other pioneers of our naturopathic heritage, includes striking parallels that are instructive and important, not only to remember, but also to implement in our naturopathic practices in the twenty-first century. Like Lust, Kneipp as a young man contracted tuberculosis at a time when this disease was synonymous with death. His salvation was a little book on cold water cure written by Dr. Johann Siegmund Hahn, which gave him enough guidance to self-administer water therapies and successfully treat and cure his tuberculosis. Kneipp describes the importance of that book in the following way:

The little volume was at first the straw to which I clung as a drowning man: it became in a short time the staff supporting the invalid; today it is the lifeboat which was sent to me by a merciful Providence in the nick of time, in the hour of extreme peril. (Lust, 1901, p. 211)

Building from this little book, Kneipp eventually modified the cold water baths to what became his signature treatment– the shower baths, or gushes.  List (not to be confused with Lust, himself) points out, however: “To apply the gush properly, though apparently a very simple thing, is an art which must be learned.” (List, 1900, p. 222)

Kneipp utilized the gushes on his parishioners with great success, reminding them to pay close attention to how they went about it. The terms “gush” and “douche” were used interchangeably by writers on the subject of Kneipp’s gush.  As Schultz reports, Kneipp, when he first began administering the gush, actually used a simple garden watering can: “Father Kneipp for many years used a common sprinkling can with the sprinkler taken off, and a wash tub.” (Schultz, 1914, p. 346) Kneipp also adopted the hose in place of the watering can to administer the gush. A simple garden hose was perfect for the gush.  As Baumgarten described the process, the stream of water flowing from the watering can or the hose did not involve any pressure, a very important aspect of the Kneipp gush in comparison to douches or showers that fell a distance of 10 to 12 feet. (Baumgarten, 1904, p. 7)

Kneipp believed that the gushes needed to be administered with the strength of the patient in mind. “It [was] the duty of the Kneipp practitioner to study the strength of the system of the patient and regulate according to it the length and strength of the gushes.” (Lust, 1900, p. 6)  For instance, Lust cautioned that  “lengthy gushes [were] not advisable, especially in the case of anemic and nervous people, or in the case of beginners, whose power of reaction has not yet been ascertained.” (Lust, 1900, p. 222)

Water Like a Sheet of Glass

Generally, the literature confirms that the aim of applying gushes, in the Kneipp sense, is to flow the water in a fan shaped stream on the body.  Kneipp emphasized, “The water must flow evenly and smoothly down over the foot.” (Kneipp, 1909, p. 494)  This spread of water like a sheet of glass is essential to obtain the results of the gush.  Baumgarten adds, “There are two points especially emphasized here, viz., flowing water and evenness of application.” (Baumgarten, 1904, p. 7)

Kneipp explains this precise methodology: “During the time the water is flowing over the body, all the warmth which otherwise would evaporate is held back and develops an increased warmth under the water, which combats with the cold pressed in by the water.” (Kneipp, 1909, 494)  The desired reaction of warmth is very quick with the Kneipp knee gush. In fact, “the more regularly and quietly the water is poured, the greater will be the warmth retained.” (Kneipp, 1909, p. 494)  Should the procedure be carelessly executed, the desired warmth would not be achieved.

The Reaction

Such action of cold water and its therapeutic reaction were of great interest to the early water cure practitioners.  In relating the signs of a properly executed gush, Baumgarten explains, “When the blood flows to the interior you will notice that the skin turns a deathly pale, but if the flow of water continues, the skin will soon turn red again, for the one who applies the water knows that he must let water flow until the skin has regained this tint.” (Baumgarten, 1903, p. 124) Where the water touches the body after the first few liters, the skin “begins to redden [and] after a few more liters the patient experiences an agreeable warmth.” (Lust, 1900, p. 222) Baumgarten stressed that “the water must then be applied evenly until, after sixty to one hundred seconds, the reaction will set in.” (Baumgarten, 1904, p. 7)  The appearance of the reaction of reddening indicated that “it is now time to stop the gushes.” (Lust, 1900, p. 222)

Circulation of blood was one of the primary goals for of the cold water applications.  This was quite true of the gushes.  These early doctors understood that moving a large volume of blood was aided by cold water.  Baumgarten explains, “The mass of blood rushing and flowing to and from the organs displaces and mingles with greater masses of blood.  The larger the displacement and the oftener it occurs, the more improved will the circulation in general be.” (Baumgarten, 1903, p. 126) Improving circulation meant warmer extremities.  With the use of cold water and its crucial importance of improving circulation, however, one central guideline was essential for success: the patient must be warm before administering cold water.


The perceived temperature of water is different when immersing a body part in cold water or applying cold water onto a body part.  Baumgarten states, “Flowing water will consume greater quantity of heat from the body than standing water.” (Baumgarten, 1903, p. 48) In his demonstration that gushes were superior, he continues, “If for instance, you will immerse your arm in a basin filled with cold water, keeping there for two minutes, then take the same quantity of water and let flow down over the arm, you will find the temperature of the standing water lower than that of the flowing.” (Baumgarten, 1903, p. 48)

Lust used water temperatures ranging from 60 to 65F [15.5 to 18C]. (Lust, 1903, p. 319) The room in which the gushes were employed should be warm and so shall the person be warm, Lust explained. List [not to be confused with Lust], a physician and surgeon of the Royal Bavarian Army contended in the same period, “It is important, also, that the gush room, as well as the person taking the gush, should be warm, and that, having taken the gush, the person should keep the blood in active circulation by quick walking.” (List, 1900, p. 222)

The Knee Gush

The most celebrated gush of all was the knee gush.  A simple definition of a knee gush is “an application of cold flowing water from the kneecap to the feet, applied in such a manner as to form a flowing sheet of water over the whole lower leg.” (Baumgarten, 1904, p. 7)  The simplicity of equipment used in the gush was misleading, giving one the impression that there could not possibly be any therapeutic implications.  Baumgarten, who worked alongside Father Kneipp, applauded the knee gush.  He wrote, “I want to say right here that the knee douche is as good in its place as any of the larger applications, and to despise it evidences a lack of insight and appreciation for what it has done to others.” (Baumgarten, 1904, p. 7)

The patient can be seated or standing in a tub, with their legs bare from the lower leg, down, exposing the knee, calves and the feet in a tub.   The gushes are carried out with a simple gardening watering can.  “The first can is to be poured out more fully and abundantly, and applied to both feet from the toes up to the knees.  The following cans are directed in a less strong jet,” (Kneipp, 1897, p. 88) moving the water can in such a way that the stream is like a sheet of glass.  “If the column of water is rightly applied you will note that it encircles the whole of the leg like a stocking, and especially if the person be seated and the water applied above the kneecap.” (Baumgarten, 1904, p. 8)  An example of how to conduct the knee gush is to start at the right foot and moved upward on the leg, “carried up as far as the middle of the calf.  From this point let the water flow so that the whole calf is covered.” (Lust, 1900, p. 6)  The left leg followed with using the same procedure. To begin the gush on the right or versus the left leg was immaterial. (Baumgarten, 1904, p. 7)

While Lust and Kneipp preferred to begin on the anterior aspect of the leg and foot, Baumgarten began on the posterior, with the heels.  Kneipp began the knee gush at “the instep, cover[ed] the foot and continue[ed] the stream upward to above the knee.” (Kneipp, 1909, p. 493)  Baumgarten recommended the gush to begin at the heel for the reason that “the calf of the leg being composed of various muscles and flesh, it is less sensitive than the shin.” (Baumgarten, 1904, p. 7) He adds, “It would be equally as well for one to begin at the front if the patient is not too sensitive.” (Baumgarten, 1904, p. 7)

Correct methodology was essential, as well as “exceptional flexibility of arm and wrist, and a quick eye to perceive the greatest coloration of the skin.” (Baumgarten, 1904, p. 8) The pouring of water was superior to bathing, in the minds of Kneipp and his adherents. The pouring allowed the practitioner some control.  “Though all processes of the cold water treatment must be administered quickly, the cooling of the body should be done slowly.” (Bauergmund, 1908, p. 71)  Bauergmund counsels, “Wet yourself only slowly and only long enough to cause a reaction to be felt.” (Bauergmund, 1908, p. 71)

Father Kneipp measured his knee gush treatments as toby the number of water cans.  “The number of cans used for a knee – shower differs from 2 to 10, each containing from 13 to 15 quarts.” (Kneipp, 1897, p. 88)  If a hose was used instead of watering cans, the knee gush lasted from one 1 to two 2 minutes.

The first application can could be received with great trepidation.  Kneipp would observe patients “trembling like aspen-leaves and in vain tried to disguise the penetrating pain caused by this water gush, which came on them like electric shocks.” (Kneipp, 1897, p. 88)  Kneipp never prescribed more than 2 watering cans for the first- time beginner and never more than 2 to 3 cans for a first treatment. (Kneipp, 1897, p. 88)  Kneipp’s protocol meant that the number of cans increased as the treatments progressed, and by the time 8 to 10 cans [were] reached, the painful sensations will disappear. (Kneipp, 1897, p. 88)

No Towels!

After the knee gush, Kneipp would instruct the patient to put dry clothing on immediately without drying with a towel, and if the constitution was strong enough, the patient would take a brisk walk for half an hour, taking care not to perspire.  (Lust, 1901, p. 56)  The use of a towel, as we can see, was contraindicated in the gush or Kneipp douche.  Getting dressed immediately after a douche or a water treatment was part of the treatment process.  Lust explains further:

This ‘not drying’ the body is the one process by which Kneipp got his greatest and best results, for this places the patient in such a state of satisfied rest, as cannot be imagine, and which must be felt and passed through by oneself to understand how beneficial it acts upon the nervous system. (Lust, 1901, p. 56)

It may seem odd that not drying could possibly be beneficial, but doing is believing.  “If the body is not dried, more warmth will be developed and appear on the surface, the blood circulates more quickly, and the assimilation is increased.” (Bauergmund, 1908, p. 71)  Bauergmund explained that by not drying and instead putting on clothing, “the water-steam between the clothes and skin affects the whole nervous system like a calming tonic.” (Bauergmund, 1908, p. 72)  It is not hard to imagine that cold water applications like the knee gush had a strengthening and hardening effect on the body as well.

Blood Circulation

The object of the gushes is “to cause the blood to circulate more rapidly, as well as to improve its quality, so that noxious matters which have accumulated in the body may be dissolved and ejected from the body. (List, 1900, p. 222-223)

The knee gush was favored by Kneipp and his followers, such as Baumgarten and Lust, “for dispersing the blood”. (Lust, 1900, p. 223)  Cold water had the action of moving the blood and increasing its circulation.  “The colder the water, the more intense the narrowing of the vessels and the quicker and the stronger the reaction.” (Bauergmund, 1908, p. 71)  Kneipp used the knee gush to help strengthen weak patients.  (Kneipp, 1909, p. 494) Another benefit of the gush was to help in the elimination of toxins.  Baumgarten explains that with the use of the gushes, “all the dormant impurities lodged here and there had been shaken up thoroughly.”. (Baumgarten, 1903, p. 50)

Baumgarten outlines further the effects of the knee gush:

The blood in the legs will rise to the upper portion of the body.  After a short time the contracted vessels will again expand, permitting the flow of blood to the extremities and reaction takes place.  This reaction continues for some time if not interrupted by drying off with a towel. (Baumgarten, 1904, p. 8)

The influence upon the body also included the whole nervous system. Baumgarten comments, “The knee-douche acts as a tonic on the whole system.  It revives, invigorates, gives new life and energy.” (Baumgarten, 1904, p. 8)  He counseled that those who felt exhausted at the end of a day of hard labour could feel completely refreshed and energized. However,  for some, such as those who were weak and hypersensitive, and those with a nervous disposition, one caution for the knee gush was to take care with these persons who were “inclined [to] experience a rush of blood to the head.” (Baumgarten, 1904, p. 8)  We may dismiss the power of this simple knee gush, but in my own practice I have learned that these small water interventions are much stronger than we can imagine.  In this regard, Baumgarten relates a story of a man who attempted several times to administer a knee gush.  The man recounts, “Every time, that I applied the douche the blood would course to my head with such rapidity that I often thought some blood vessel would burst.” (Baumgarten, 1903, p. 48)

Kneipp prescribed the knee gush for “urinary trouble, diseases of the stomach and kidney, and for removing headaches … and even sore throats are relieved by this douche because of its power to strengthen and draw the blood downwards.” (Kneipp, 1909, p. 494)  Kneipp recommended the knee gush for “those who suffer constantly from cold feet.” (Kneipp, 1909, p. 494)  For rheumatism and arthritis, “there is no known remedy which will relieve the pain quicker than the knee-douche on the inflamed limb.” (Baumgarten, 1904, p. 10)  The knee gush helped remove “headaches which are caused by too much blood in the head.” (Kneipp, 1909, p. 494) The knee gush was employed in conjunction with the upper gush for women with dysmenorrhea and menorrhagia.  “The knee gush influences the muscular tissue of the womb … and stops bleeding.” (Lust, 1900, p. 76)  Lust explained that the upper gush revulsed blood from the lower pelvic area to the upper part of the body.  (Lust, 1900, p. 76)

It is one thing to read or write an article based upon the old ways; it is another to actually do it!  We all have garden hoses, or watering cans to put Kneipp’s golden treatment to the test.  You can counsel your patients that the next time they are feeling exhausted at the end of a long and tiring day, they should just turn on the cold water. The whole treatment will only take a couple of minutes.  There is never any harm to from experimenting. Baumgarten, the consummate experimenter, himself, asserts,

“In conclusion, I wish to draw your attention to the fact that the knee-douche should not be applied too long, and always ended when the skin reddens.” (Baumgarten, 1904, p. 10) 


Dr Sussanna Czeranko

Sussanna Czeranko, ND, graduate of CCNM, is a licensed in Ontario and in Oregon.  Practicing since 1994, she has developed an extensive armamentarium of nature-cure tools and techniques for her patients and has an especial interest in balneotherapy, and breathing therapy.  As Curator of the Rare Books Collection at NCNM, her present projects include an eleven11-book series entitled In Their Own Words, soon to be published by NCNM Press.  This series will restore the best of the early literature from the Lust Journals for the profession.  Sussanna is the founder of The Breathing Academy, a training institute for naturopaths NDs to incorporate a scientific model of breathing therapy called bButeyko into their practice.  Her next large project is to complete the development of her new medical spa in Manitou Beach, Saskatchewan.


1. Bauergmund, (1908). How should Kneipp’s treatments be taken? The Naturopath and Herald of Health, IX(3), 69-76.
2. Baumgarten, A. (1903). The Kneipp cure. The Naturopath and Herald of Health, IV(3), 48-51.
3. Baumgarten, A. (1903). Water applications. The Naturopath and Herald of Health, IV(5), 124-126.
4. Baumgarten, A. (1904). The Kneedouche, The Naturopath and Herald of Health, V(1), 7-10.
5. Kneipp, S. (1897). My Water Cure.  Kempten, Bavaria: Jos. Koesel Publisher, Kempten, Bavaria, pp. 395.
6. Kneipp, S. (1902). The Kneipp hip-douche. The Naturopath and Herald of Health, III(3), 141.
7. Kneipp, S. (1902). The full douche. The Naturopath and Herald of Health, III(6), 266-268.
8. Kneipp, S. (1902). The Kneipp hip-douche. The Naturopath and Herald of Health, III(5), 213-214.
9. Kneipp, S. (1909). Kneipp’s cold water douches. The Naturopath and Herald of Health, XIV(8), 492-499.
10. List, N. (1900). What is the nature of the Kneipp treatment. The Kneipp Water Cure Monthly, I(12), 220-223.
11. Lust, B. (1900). The Kneipp gushes or pours. The Kneipp Water Cure Monthly, I(1), 6-7.
12. Lust, B. (1900). Abdominal complaints of women. The Kneipp Water Cure Monthly, I(4), 75-76.
13. Lust, B. (1900). The Kneipp gushes or pours. The Kneipp Water Cure Monthly, I(12), 220-223.
14. Lust, B. (1901). The process of not drying oneself, according to the Kneipp water treatment. The Kneipp Water Cure Monthly, II(2), 56-57.
15. Lust, B. (1901). The Kneipp cure. The Kneipp Water Cure Monthly, II(8), 210-212.
16. Lust, B. (1903). Health incarnate, means of hardening for children and adults. The Naturopath and Herald of Health, IV(11), 313-321.
17. Schultz, C. (1914). Hydrotherapy or water cure. The Naturopath and Herald of Health, XIX(6), 345-349.

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