Hydrotherapy is often of great value in restoring compensation by
improving the surface circulation. Sponging with hot, tepid or cold
water, as indicated, will increase the peripheral circulation and
the normal secretions of the skin.
When compensation is perfect, in valvular lesions, more or less
frequent warm baths are advisable, and often relieve the heart by
equalizing the circulation. Cold sponging in the morning may be
advisable, but may do harm when there is high tension; warm, not too
hot, baths are of value. Anything is of value that improves the
peripheral circulation and prevents the extremities from being cold.
The value of the Nauheim or other carbonated baths is perhaps often
a question. They have seemed in many instances to aid in improving
compensation in such patients as have been able to go abroad for the
treatment. On the other hand, so many other regimens are ordered and
inaugurated for these patients at these "cures" that it is hard to
decide how much benefit the baths have really done. At home the
artificial carbonated or carbonic acid baths do not seem to be of
great value. Baths and bathing can do harm, and the decision as to
which hydrotherapeutic measure shall be used can be made only after
careful observation of the patient by the physician.
Gentle massage while the patient is in bed is of undoubted value;
more vigorous massage is later often of value, provided there is no
arteriosclerosis. As the patient grows stronger and the circulation
improves, the muscles are kept in good condition during the enforced
rest by massage. When properly applied, it promotes not only the
venous return circulation, but also the lymphatic circulation; it
often removes muscle aches and muscle tire and restlessness.
While the patient is still in bed, various resistant exercises are
of value, and should be begun. These tend to prepare the patient for
his later greater activities; the surprise to the heart when the
patient begins to sit up and walk is not so great if he has
previously taken these exercises. Later, when the patient is
ambulatory, he should by gradual gradation walk a little more about
the house and take a few steps of the stairs at a time, until
gradually he is able to mount the whole flight. Later he should take
out-door exercise, and when his heart has become compensated for
ordinary work, he should be given gradually graded hill-climbing
with the idea of increasing his reserve cardiac power. If it is
found that these increased exertions cause him to have pain or a
more rapid heart than is excusable, even after persisting for a few
days, the attempt to increase this reserve power of the heart should
be abandoned. There is probably, at least at that particular time,
considerable myocarditis, although the heart may eventually
recuperate still more. Pushing it to overexertion, however, will not
accomplish improvement. Some of the simple "tests of heart strength"
described under that heading may be used with these patients.
Graded exercise was first used scientifically by Oertel and Schott,
and has been for years designated by their names. Modifications of
their rigid rules are generally advisable.