This treatment, consisting of effervescing saline baths and resistive exercises, is frequently used in conjunction with massage. Like massage, it should never be undertaken except by the direction and under the supervision of a medical man, and it is important that in heart cases, for which it is principally ordered, it should be undertaken by a trained nurse, as during the exercises and baths the operator should be capable of appreciating the slightest change in the countenance or breathing of the patient.

The exercises in no way differ from the Swedish exercises. Of the three varieties, ' passive,' ' active,' and ' resistive,' the last-named is the chief accessory to the bath ; at the same time, it is wise sometimes to commence treatment with passive exercises.

Passive movements relieve the heart ; resistive movements quicken the circulation in the muscles brought into action, and reflexly induce contraction of the cardiac muscles. Their aim is to cause slight exertion without fatigue, and to increase peripheral circulation.

The resistance is graduated, being at first, perhaps, not more than the weight of the operator's hand

At Nauheim and elsewhere the resistance is either manual or mechanical as the physician may decide.

At first movements of the upper extremities only are permitted ; afterwards those of the lower extremities and trunk are added. A pause should occur between each movement, from half a minute to a minute. They should not be given within an hour and a half after a full meal.

The dress should be quite loose, so that no part of the body may be constricted and the circulation thus retarded, neither should pressure be made on bloodvessels by the operator's fingers.

Other rules to be observed are that no movement should be repeated on the same limb.

The patient should count in a whisper to encourage regular breathing and to prevent holding of the breath. Movements to be performed at a uniform rate, always slowly.

Care must be taken in movements in which the arms are raised to the head, as syncope might result from backward rush of blood. In bad cases the arms should not be raised above the level of the shoulder without special directions.

Should signs of exhaustion appear, such as palpitation, yawning, hurried breathing, dilated nostrils, the corners of the mouth be drawn, the cheeks or lips become pale, or moisture appear on lips or forehead, the movements must be discontinued, and the patient placed in a restful position for some time.

The exercises may be given in a reclining position, or sitting or standing, according to the condition of the patient. The exercises and baths may be employed separately or conjointly.

Besides chronic heart diseases, this treatment is used for the weakened heart left by influenza, acute and chronic gout, rheumatism, asthma, anaemia, and neurasthenia.