Disturbances of the Heart / Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood Pressure

by Oliver T. Osborne

NAUHEIM BATHS

At Nauheim, under the direction of Dr. Theodore Schott, baths form an important part of the treatment. These baths are of two kinds, the saline and the carbonic acid. The medicinal constituents of the saline bath are sodium chlorid and calcium chlorid, the strength of each varying from 2 to 3 percent The baths at first arc given at a temperature of 95 F., and as the patient becomes used to them and can take them without discomfort, the temperature is gradually reduced. The patient remains in the bath from five to ten minutes. After the bath he is dried with towels and rubbed until the cutaneous circulation becomes active. He must then lie down for an hour. These baths are repeated for two or three days, and are omitted on the third and fourth days, to be resumed on the following day. After a few baths have been taken, the carbon dioxid baths are commenced, beginning with a small quantity of the gas which is later gradually increased. This course of baths should be continued from four to eight weeks. Unless there is some special reason for taking them at some other period of the year, they are taken more advantageously during the warm months.

Besides the baths, all important part of the treatment at Nauheim consists in the exercises against resistance. These are usually given an hour or more after a bath, and are taken with great deliberation; their effect is carefully watched by an intelligent attendant so that no harm may be done by the exercise.

During this treatment the food is, of course, carefully regulated with the aim of giving a mixed, sufficient, easily digestible and easily assimilated diet. All highly seasoned dishes, all effervescent drinks and anything that tends to cause gas in the stomach and intestines are prohibited. Coffee and tea are not allowed, except coffee without caffein; and it may be noted that it has recently been shown that caffein is one of the surest of drugs to raise the blood pressure, and is therefore generally not desirable when the heart muscle requires strengthening. Because of its tendency to raise blood pressure and weaken cardiac muscle, tobacco is entirely forbidden at Nauheim, except in a few individual instances, and then the amount allowed is a minimum one. Large amounts of liquid are not allowed because they distend the stomach, raise the blood pressure and increase the pumping work of the heart.

One of the greatest advantages of the treatment at an institution like Nauheim is the general hopeful spirit instilled into the patients, who are so many times seriously depressed by the knowledge of a heart weakness and the realization of their physical inability to do what other persons are able to do. Also, it is of great value to send a patient to a resort where the climate is good and the scenery is lovely and soothing. No disease, perhaps, needs cheerfulness and pleasantness and lack of anxiety, or frets more than does cardiac weakness. A tuberculous patient may sit on a mountain top with snow blowing about him, and recover; a heart patient must have sunshine and comfort.

The results of such sanatorium treatment of heart disease are often evident not only to the patient by an increase of general muscle strength, the ability to do ordinary things and perhaps even sustain muscular effort without dyspnea and cardiac discomfort, but also to the physician by the physical signs. The contraction of the heart becomes stronger and the normal sounds more decided; murmurs which were entirely due to dilated ventricles and insufficiency disappear, while the permanent murmurs may become louder from a more forceful, normal action of the heart muscle. The pulse becomes slower, and the blood pressure, from being too low, becomes normal for the age of the individual. The heart will often also actually decrease in size, and the apex beat become localized rather than diffuse, The liver becomes reduced in size; the urine is less concentrated, and if there were traces of albumin after exertion, these disappear.

It should perhaps be emphasized that not a little benefit from these resort treatments may be due to the withdrawal of unnecessary drugs. Many heart patients are overdrugged.

This sort of treatment is contraindicated in some kinds of heart disease, as heart weakness due to arteriosclerosis with high blood pressure, to aneurysm of the thoracic or abdominal aorta, and to nephritis.

So many heart patients have been improved by the Nauheim treatment that the question arises as to whether the treatment can be conducted at home or in a sanatorium near home, when the patient is unable to go to this resort; that is to say, Can we establish this treatment for the majority of patients who have chronic heart disease? Of course, even at home, the sodium chlorid and calcium chlorid baths may be given, and one may obtain the salts all prepared to make the carbon dioxid bath; the exercises may be given, and walking on various ascending grades may be inaugurated. All patients will be more or less benefited, provided they will carry out the treatment. Unfortunately, the surroundings at a patient's home are generally adverse to perpetuating these treatments long enough to develop the muscular strength of the heart to the reserve desired. If a patient appears pretty well, especially if he is stimulated by his family to believe that he is well, he thinks the continuation of the treatment entirely unnecessary, and unless he goes to a resort where he sees other patients with similar conditions able to do what he is not able to do, and therefore is stimulated to acquire their ability by the treatment outlined, he will not follow his physician's directions. There are several sanatoriums in this country where the diet, hydrotherapy and exercise necessary for developing heart strength are carried out, and patients are sent to some of them with great advantage.

It has been found that these stimulant baths do not act well in mitral stenosis, if the left ventricle is small. If the left ventricle is unable to receive and therefore send out into the systemic circulation sufficient blood to dilate the peripheral capillaries under the irritation of the baths or the vasodilator effects of the baths, the bath treatment does harm instead of good. A patient who has mitral stenosis and also a small left ventricle will be found to be poorly developed, badly nourished, and to have poor peripheral circulation.

As elsewhere stated, the improvised carbon dioxid bath, to stimulate the skin so as to reduce the blood pressure, is not satisfactory. Other methods of reducing blood pressure, when it is too high, are much more effective.