MODERN DEVELOPMENTS OP HARVEY'r WORK. 473 



endeavors to produce these beuetieial changes in our patients we employ 

 regimen, diet, and drugs, and it is evident that as in one case the con- 

 dition of a patient's heart may be very different indeed from that in 

 another, the regimen which may be useful to one may be fatal to the 

 other. We have already seen that sudden and violent exertion may 

 raise the blood pressure and so lead to intense cardiac pain or to stop- 

 page of the heart and instant death, while more gentle exercises, by 

 increasing the circulation through the muscles, may lessen the pressure 

 and give relief to the heart. 



The methods of increasing the muscular circulation may be roughly 

 divided into three, according as the patient lies, stands, or walks. 

 First, absolute rest in bed with massage;' second, graduated move- 

 ments of the muscles of the limbs and body while the patient stands 

 still; third, graduated exercises in walking and climbing. 



The second of these methods has been specially worked out by the 

 brothers Schott, of Nauheim, and the third is generally connected with 

 the name of Oertel. It is obvious that in cases of heart disease where 

 the failure is great and the patient is unable even to stand, much less 

 to walk, where breathlessness is extreme and dro[)sy is present or 

 is advanced, the second and third methods of treatment are inappli- 

 cable. It is in such cases that the method of absolute rest in bed, not 

 allowing the patient to rise for any purpose whatever, hardly allowing 

 him to feed himself or turn himself in bed, proves advantageous. The 

 appetite is usually small, the digestion imperfect, and flatulence trouble- 

 some; and here an absolute milk diet, like that usually employed in 

 tyjihoid fever, is often most serviceable, being easilj^ taken and easily 

 digested, while the milk sugar itself has a diuretic action and tends to 

 reduce dropsy. But while simple rest prevents the risk of increased 

 arterial tension and consequent opposition to the cardiac contractions 

 which might arise from muscular exertion, such benefits as would accrue 

 from muscular exertion and increased circulation would be lost were 

 t not that they can be sui)plied artificially by massage. This ])lan of 

 treatment, although it has only recently been revived, was known to 

 Harvey, who narrates the case of a man who, in consequence of an 

 injury — of an effront which he could not revenge — was so overcome 

 with hatred, spite, and passion that ''he fell into a strange disorder, 

 suffering from extreme compression and i)ain in the heart and breast, 

 from which he only received some little relief at last when the whole 

 of his chest was pommeled by a strong man, as the baker kneads 

 dough."' 



This was a very rough form of massage, but the same kneading 

 movements which Harvey described have been elaborated into a com- 

 plete system, more especially by Ling, in Sweden, and made widely 

 known in America and this country by S. Weir Mitchell and Playfair. 



' Practitiouer, Vol. LI, page 190. 



*Tlie Works of William Harvey, Sydeuham Society's edition, page 128. 



