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DISEASES OF THE HEART

Massage and movements are indicated in affections of the heart caused by nervous debility, anemia, diseases of the stomach, etc. The movements mostly used are:

Sitting, raising of the chest, with shaking, to produce strong respiration;

Rotation of the extremities, to assist the heart in its action;

Rotation and turning of the body, to give effect upon the great venous system;

Centripetal stroking, to remove the subcutaneous effusions.

In organic diseases of the heart, movements are recommended by some of the most eminent physicians. They apply movements to support the heart in its action, generally using such as will increase the circulation in the distant parts of the body.

Within the last few years a new system of exercise for heart-affections has been developed by Dr. August Schott, of Bad Nauheim, Germany. The results have at times been remarkable. He employs the effervescent Nauheim water, as a rule daily, and directs a series of resistive exercises (original Swedish movements) to be given daily, or every other day if the patient is too weak. The general massage— gently applied—is too often lost sight of as a most excellent preparation for this particular movement cure. All the movements are duplicated-active,

and the resistance should be so applied as not to interfere with the circulation—preferably, when possible, with the palmer surface of the hand. Every movement should be performed slowly, and the operator should watch his patient most carefully. At first the séance should last but ten minutes, to be gradually and carefully increased to thirty minutes. A rest should be allowed after each movement, and no exercise is to be applied more than once in each series. The operator should carefully guard against the following symptoms:

• 1. Intermission of the pulse.
• 2. Weakness of the pulse.
• 3. Increased respiration.
• 4. Palpitation of the heart.
• 5. Dilatation of the nostrils.
• 6. General feeling of discomfort.

When any of the above-mentioned symptoms appear allow a few minutes' rest; or, if necessary, stop the treatment for the day. It is customary to take the pulse and respiration before starting, during the middle of the séance, and at its close. A careful record should be kept for the reference of the attending physician.

The principal Schott exercises are:

• 1. Separating and closing of arms.
• 2. Flexion and extension of arms.
• 3. Raising of the arms upward.
• 4. Rotation of the arms.
• 5. Pronation and supination of the forearm.

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• 6. Flexion and extension of the hand.
• 7. Flexion and extension of the fingers.
• 8. Abduction and adduction of the fingers.
• 9. St. bending of the body forward and backward.
• 10. S. bending of the body sideways.
• 11. S. rotation of the body.
• 12. Same as 1, with clenched fist.
• 13. Same as 2, with clenched fist.
• 14. St. arms extended forward and backward.
• 15. L. flexion and extension of the leg.
• 16. L. flexion and extension of the foot.
• 17. L. separation and closing of the thighs or legs.
• 18. St. leg extended forward and backward.

Careful operators are sometimes requested to apply treatment locally; then use massage of the chest, as previously described, with hacking in small circles over the cardiac region. Palmar vibrations are also used. In the European institutes of medical gymnastics it is quite common to see the vibrations applied over the heart. The operator then places his arm upon the artificial vibrator and the wave-like movements are transferred to the cardiac region through the semi-flexed and abducted fingers. Except when especially requested by a physician, however, this local application is seldom used. Gentle respiratory movements should always form the conclusion of the treatment, and an hour's rest should be rigidly insisted upon.