Baths And Exercises In Heart Disease
( Originally Published 1921 )
From what has been written so far, it must be evident to the most casual reader that there are two elements in heart disease; one consisting of material disorders showing change in the structure or arrangement of the organs of circulation, and the other consisting of changes in the activities of these organs, or, as it is sometimes exprest, "functional disorders."
Changes of function are brought about by physical means. Physical exercise in a healthy person increases the circulation, rest decreases the circulation; a plunge into cold water is followed by a healthy glow, a long time spent in warm water causes debility, and so on. These are examples of functional changes brought about by physical means. It is observed that when functional disorders last for a long time, organic and structural changes take place; and it is likewise observed that when functional disorders are suspended for a long time organic changes have a tendency to disappear.
While to many people with heart disease exercise is for the time being to be forbidden, there are other times when it becomes a valuable adjunct in strengthening the heart. Not only is this true, but there are certain forms of gymnastics that have the power of regulating the tone of the blood vessels and increasing the tone of the heart. So it comes about that exercise available in one form or another to many who have heart disease.
The most elaborated system of baths and exercises for heart disease is known as the Nauheim-Schott system in which waters resembling those of Nauheim are used in the baths, and the Schott resistance movements are employed for gymnastics.
The baths consist of cool, carbonated waters with a strong solution of brine. They should be taken only under medical direction, but when properly given have value. They can be imitated by artificial baths in any part of the world. It is not necessary to go to Nauheim for them.
The exercises consist in gently bringing into play all the principal muscles of the body by movements on the part of the patient which are gently resisted by the gymnast. The accompanying pictures show some of the movements and others can be inferred from these, bearing in mind that all the muscles of the body are to be brought into play in turn.
Simple exercise in the form of walking is valuable in weak heart, beginning with a short distance and gradually increasing the distance each day. In general, the question of exercise is one of the most difficult with which physicians have to deal. One person will be so frightened that he will remain quiet to the degree that his health suffers; such a one must be urged to take exercise. Another will insist upon taking part in violent contests, and it is necessary to be very stern in preventing such recklessness. As- a rule, it is best to interfere as little as possible with the man's life-work.
A child with heart disease should avoid foot-ball, long runs, and training for races, but should do almost anything else, such as tennis, horseback-riding, bicycling on the level, and such games of skill as fencing, etc. Any distress or loss of breath should be a sign to stop. In high blood pressure warm bathing is often of service, and in low pressure hot baths are the best possible treatment. Warm bathing is highly appropriate to any form of heart disease, tho cool baths are the only ones that are really beneficial in the Nauheim treatment ; by cool baths I mean 78° to 90° F.
By judicious bathing and exercise, a person with heart disease can help himself a great deal. In the regulation of these measures the sufferer must always be guided by the advice of an experienced physician. Without such advice and when guided by his own feelings, he will be likely to exercise either too much or too little, and he will be tempted to submit to baths unskillfully applied which may do serious damage.
To learn the resistance exercises the nurse should apply to some skilled operator to show her by personal example how they are given; only in this way can the amount of force employed be determined.
In preparing the Nauheim bath it is well to employ some well recommended, ready-made preparation, but it is possible to give satisfactory baths by the following method: For the production of carbonic effervescence the action of hydrochloric acid and bicarbonate of soda may be relied upon. As a state of chemical purity is not required by the circumstances of the case, the articles 6f commerce are sufficient for the purpose.
To each bath of fifty gallons add 10 to 20 lbs. of sodium chloride, and 1 to 2 lbs. of calcium chloride may be added. A patient is enabled to take a saline bath of this density at a low degree of temperature, and from two to four saline baths should be given before the effervescence series. The effervescent bath with a temperature above 90° is practically useless. As the patient becomes accustomed to these baths, the temperature should be lowered. That is, starting the first bath at a temperature of 90°, then as the series progresses, gradually reduce the temperature of the water to 78° F. After the sodium chloride and calcium chloride have been dissolved, the bath is ready for the artificial effervescence; and to produce this, the following table should be employed, as suggested by Dr. Ralph Grace:
Sodium Bicarbonate Hydrochloric Acid No. 1. Mild 10 oz.9 oz.No.2. Medium1S oz.12 oz.No.3. Strong (Sprudel strength) 2S oz 24 oz.
The sodium bicarbonate should be dissolved in water and mixed with the salt water bath. The hydrochloric acid is then measured and poured on the surface, distributing it equally .over the entire bath. Effervescence begins at once, and the subject should be ready to step into the bath immediately. The tub should be of sufficient length so that the entire body may be covered. Different-sized foot rests may be put at the foot of the tub, so that persons of varying heights may rest their feet against them, allowing the bath to envelop them to the chin.
The duration of the bath is usually five to fifteen minutes, but should be adapted to the needs of each person.