The Art of Massage J. H. Kellogg, M.D. 1895   APPENDIX II  
 
    The so-called Schott method of treatment, employed by the Schott brothers, of Nauheim, Germany, in connection with the effervescing chloride of calcium baths, has acquired a great reputation, not only in Germany, but in England, where it is now much in vogue, especially in hospitals and sanitariums.
    While this method is as yet little employed in this country, and seems to have been practically unknown in Germany until introduced by the brothers Schott, it is but fair to state that it presents no, features essentially different from the system of manual Swedish movements which has for more than fifty years been employed in Sweden, Norway, and Denmark, by the practitioners of the so-called Ling, or Swedish, system of curative gymnastics.
    Although we have no definite knowledge upon the subject, we feel confident that careful inquiry into the origin of the "Nauheim treatment" would show it to have been derived from the Swedish system. Great credit is due to the Schott brothers for having so thoroughly systematized the method, and for having by persevering and successful effort brought it to the attention of the medical profession in so favorable a manner as to command attention and respect. Under this form, the writer has for the last twenty years employed gymnastics in the treatment of cardiac affections. The exact procedure, as the system is now in use at the Battle Creek Sanitarium, under the author's direction, may be thus briefly described:

    Exercise. - Each of the following movements is taken with resistance in both directions.
    1. Arms forward stretch, sidewise moving, returning.
    2. Arms downward stretch, forearm flexion and extension.
    3. Arms downward stretch, forward upward moving, returning.
    4. Fingers flexed, knuckles in contact at umbilicus, - arms raising to vertex, returning.
    5. Arms downward stretch, forward raising to upward stretch.
    6. Trunk forward bending; resistance, (a) hands sternum and loins; (b) hand at upper spine.
    7. Trunk rotating; resistance (a) left hand in front of patient's right shoulder, right hand behind patient's left shoulder; (b) reversed.
    8. Lateral trunk flexion; resistance, attendant in front of patient, (a) right hand under patient's left arm, left hand on patient's right hip; (b) reverse.
    9. Same as 1, except fist firmly clenched.
    10. Same as 2, except palmar surface is turned out, and fist firmly closed during exercise
    11. Arm circumduction, one arm at a time.
    12. Arms backward raising - trunk must not bend forward.
    13. Knee raising, body balanced by support of opposite hand.
    14. Leg forward and backward raising.
    15. Leg backward flexing; hand support.
    16. Leg outward raising.
    17. Arms rotating, extreme degree.
    18. Wrist flexion and extension.
    19. Foot flexion and extension.
 

RULES PERTAINING TO EXERCISE

    1. Movements must be slow and uniform.
    2. Follow each movement by an interval of rest.
    3. Movements of' the same limb or group of muscles should not be repeated twice in succession.
    4. Movements should be immediately interrupted if any, of the following symptoms appear, and the patient must be watched closely to avoid the development of these signs, which indicate exhaustion:
    (1) Accelerated breathing.
    (2) Marked movements of the nares in breathing.
    (3) Slight drawing of the corners of the mouth.
    (4) Pallor or duskiness of the cheeks or lips.
    (5) Palpitation of the heart.
    (6) Sweating.
    (7) Yawning.
    If any of. the above signs should appear in the midst of the movement, the exercise must be instantly :suspended, the limbs being carefully placed in a state of rest.
    5. The patient should not be allowed to hold the breath. To prevent this the patient should count in a whisper from 1 to 8 while the movement is being executed,. or during each half of it.
    6. Constriction of the limbs or any other portion of the body whereby the blood-vessels may be compressed, must be carefully avoided.
    7. The force of the movement must be very carefully graduated to the strength of the patient. It is sometimes necessary to employ only the very gentlest resistance. Patients who are bedridden, and those who are very feeble cannot at first take all the movements, but must take only such as are adapted to their condition or strength.
    8. Examination of the heart, should be very carefully made in every case before beginning treatment. In cases of emphysema, asthma, and in obstruction of the aortic orifice, great care must be taken, especially with the arm-raising movement, to avoid producing syncope, on account of the obstruction of the pulmonary circulation. The same rule applies to any condition in which the respiratory area is diminished, as in pleurisy with effusion, consolidation of the lung, dropsy of the chest, pyothorax, or pneumothorax.
    9. In these cases the movements must be executed very slowly, so as to give time for the distribution of the blood. They may have to be taken while the patient is lying down. The right side of the heart being overloaded in these cases, the arm movement should not at first extend above the level of the shoulders, unless the patient is reclining, as the extension of the right heart would be increased by giving the blood the down grade in the arteries.
    10. Special attention should be given also to the patient's regimen and diet by enforcing an aseptic dietary. Such exercise as graduated mountain climbing is too severe for patients requiring this treatment. It is only adapted to cases which have made considerable advancement toward a cure. The object of the method is not to strengthen the muscles, but to regulate the circulation.
    11. The patient may, to some extent, administer the exercise himself, by executing the various movements, producing the resistance by hardening the muscle, as though working against the resistant force.

    Baths. - The purpose of the baths is to dilate the peripheral, and stimulate the arterial circulation.
    The bath contains graduated quantities of chloride of sodium and chloride of calcium, as follows:

        Chloride of sodium 1 %, chloride of calcium 2 %
        Chloride of sodium 2%, chloride of calcium 3%.
        Chloride of sodium 3%, chloride of calcium 5%.

Effervescence in three grades is produced by adding sodium bicarbonate and hydrochloric acid in varying quantities as follows:
        Sodium bicarbonate ½ lb., hydrochloric acid (25%) 3/4 lb.
        Sodium bicarbonate l lb., hydrochloric acid (25 %) 1 1/2 lbs.
        Sodium bicarbonate 2 lbs., hydrochloric acid (25%) 3 lbs
    If a copper tub is used, one-fourth extra amount of bicarbonate should be employed to protect the copper from corrosion.
    In mixing the ingredients, first dissolve the bicarbonate of soda in water in the tub. Then, for slow effervescence place the bottle containing the acid, with stopper removed, at the bottom of the bath, laying it down upon the bottom, and moving it around from time to time. The bath will be ready in two or three hours. For rapid effervescence, invert the bottle without removing the stopper, place the mouth of the bottle just below the surface of the water, withdraw the stopper, and move the bottle about over the surface of the bath, so as to distribute a uniform layer of acid. By this means the bath is prepared in five minutes. The temperature of the bath should be 92 ⁰F.
    Generally the bath should be taken only two or three days in succession, one day's respite being allowed. With stronger persons four or five successive baths may be given. The chloride of calcium and the chloride of sodium increase the skin excitation. The effect of the bath should be to slow the pulse, to lessen the area of cardiac dullness, and to increase the force of the pulse. Examination of the cardiac area should be made before the bath, and marked on the chart, a diagram being preserved in each case. Sphygmographic tracing of the pulse should also be made, the blood pressure being determined with the sphygmo-manometer. Full directions for the use of the effervescent bath and other baths applicable to cardiac cases will be found in the author's handbook of " Rational Hydrotherapy."¹

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1. The F. A. Davis Co., Philadelphia, Pa.