22 THE I.IAKVEIAN OEATIOX, 1894. 



and his scholars. The clinical results are precisely what one 

 would expect from increased circulation in the muscles, and 

 cases apparently hopeless sometimes recover most wonderfully 

 under this treatment. 



For patients who are stronger, so that confinement to bed is 

 unnecessary, and who yet are unable to take walking exercise, 

 Schott's treatment is most useful, and it may be used as an ad- 

 junct to the later stages of the treatment just described, or as a 

 sequel to it. Here the patient is made to go through various 

 exercises of the arms, legs, and trunk with a certain amount of 

 resistance, which is applied either by the patient himself setting 

 in action the opposing muscles, or by an attendant, who gently 

 resists every movement made by the patient, but graduates his 

 resistance so as not to cause the least hurry in breathing, or the 

 least oppression of the heart. Perhaps the easiest way of em- 

 ploying graduated resistance is by the ergostat of Gartner, 

 which is simply an adaptation of the labour crank of prisons, 

 where the number of turns of a wheel can be regulated in eacli 

 minute, and the resistance, which is applied by a brake, may be 

 graduated to an ounce. The objection to it is the uniformity of 

 movement and its wearisome monotony. 



Oertel's plan of gradually walking day by day up a steeper 

 and steeper incline, and thus training tlie cardiac muscle, is well 

 adapted for strong persons, but when applied injudiciously, may 

 lead, just like hasty or excessive exertion, to serious or fatal 

 results. In Scliott's method stimulation of the skin by baths is 

 used as an adjunct, and this may tend to slow the pulse as 

 already mentioned. But in all these plans the essence of treat- 

 ment is the derivation of blood through a new channel, that of 

 the muscular vessels ; and the results in relieving cardiac dis- 

 tress and pain may be described in the same words which 

 Harvey employs in n^ference to diseases of the circulation : 

 " How speedily some of these diseases that are even reputed in- 

 curable are remedied and dispelled as if by encliantment."* 



There is yet another consequence of the circulation to which 

 Harvey has called attention, although only very briefly, which 

 has now become of the utmost importance, and that is the ad- 



■* The WorJcs of William Harvei/, Sydenham Society's edition, p. 141. 



