Nauheim Baths

Categories: Uncategorized
Sources: Disturbances Of The Heart

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 withou 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.