20 THE IIARVEIAN ORATION, 1894 



sure caused by inability to empty itself produces, as I liave 

 already said, intense pain. 



A knowledge of the mode of the circulation of blood through 

 the muscles enables us to understand not only the pathology of 

 angina pectoris, but the rationale of various methods of treating 

 patients suffering from angina pectoris or other forms of heart 

 disease. In most cases our object is a two-fold one — to increase 

 the power of the heart, and to lessen the resistance it has to 

 overcome. In some cases we require also to aid the elimination 

 of water, whicli has so accumulated as to give rise to oedema of 

 the cellular tissue, or dropsy of the serous cavities. In our 

 endeavours to produce these beneficial changes in our patients, 

 we employ regimen diet, and drugs, and it is evident that as in 

 one case the condition 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 stoppage of the heart and 

 instant death ; while more gentle exercise, by increasing the 

 circulatioi: of the muscles, may lessen the pressure and givo 

 relief to the heart. 



The methods of increasing the muscular circulation may be 

 roughly divided into three, according as the patient lies, stands, 

 and walks. First, absolute rest in bed with massage* ; second, 

 graduated movements of the muscles of the limbs and body 

 wdiile the patient stands still ; third, graduated exercises in 

 walking and climbing. 



The second of these methods has been specially worked cut 

 by the brotliers Schott, of jSTauheim, 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 walk, 

 where breathlessness is extreme and dropsy is present, the 

 second and third methods of treatment are inapplicable. It is 

 in such cases that the method of absolute rest in bed, not allow- 

 ing the patient to rise for any purpose wdiatever, hardly allowing 

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



* Lauder Brunton, Practitioner^ vol. li, p. 190. 



