The Baths of Nauheim in the 
Treatment of Diseases 
of the Heart 
AND THE THERAPEUTIC METHODS 
OF THE DOCTORS SCHOTT. 
WILLIAM C. RIVES, M. D., 
BY 
Lecturer on Diseases of the Chest and on General Medicine 
in the New York Polyclinic. 
REPRINTED FROM THE 
Netu York JJHetncal journal 
for April If 1896. Reprinted from the New York Medical Journal 
for April 11, 1896. 
THE BATHS OF NAUHEIM IN THE 
TREATMENT OF DISEASES OF THE HEART 
AND THE THERAPEUTIC METHODS OF 
THE DOCTORS SCHOTT. 
WILLIAM C. RIVES, M. D., 
LECTURER ON DISEASES OF THE CHEST AND ON GENERAL MEDICINE 
IN THE NEW YORK POLYCLINIC. 
The remarkable and in some respects unique results 
attained at Nauheim in cases of heart disease have begun 
recently to excite much interest and attention, and it is 
highly desirable that the particulars of a treatment which 
has proved to be an invaluable addition to our resources 
for the relief of a numerous class of sufferers should become 
as far as possible widely known. 
The baths of Nauheim, with a resident population of 
three thousand inhabitants, lie at the foot of the eastern 
end of the Taunus range, at an elevation of four hundred 
and fifty-three feet above the sea, on the edge of the level 
and fertile plain-the Wetterau-which extends thence to 
the river Main. They are three quarters of an hour dis- 
tant by rail from Frankfort on the line from that city to 
Cassel and Hanover, and within easy driving distance of 
the well-known and more fashionable health resort of Hom- 
burg. 
Copyright, 1896, by D. Appleton and Company. 2 
THE BATHS OF NAUHEIM 
A straight road leading downhill from the station 
brings the visitor in a few minutes through the newer part 
of the town, which consists almost exclusively of villas for 
the accommodation of guests, to a street bordering in a 
semicircle a spacious and singularly well laid out park 
adorned with many beautiful trees. 
From this point the town proper is quickly reached, 
presenting in itself few features of interest. It lies imme- 
diately to the south of the park, to the west of which is 
still another district of villas, occupying the lowest slopes 
of the Johannisberg. 
The attention of the stranger is at once arrested by a 
number of large, unsightly structures in the plain adjoining 
Nauheim, fifty feet high, and more than a hundred and 
fifty long-the Gradirhauser, or graduating houses, used in 
the process of making salt, which is manufactured there in 
large quantities. The old town of Friedberg, with its 
ancient walls and towers, only a mile distant, is a most 
picturesque object in the landscape, and from various points 
can be seen the Winterstein, the highest elevation in this 
part of the Taunus range. 
In the midst of the park, near the banks of the little 
river Usa, burst forth the- springs supplying the bath 
houses, on which the fame of Nauheim depends. These 
come from a great depth (five hundred and twenty-three 
and five hundred and ninety feet), and were found by means 
of borings made at different times in the course of this 
century. The two now in use-No. 7, Grosser Sprudel, and 
No. 12, the Friedrich Wilhelm's Quelle (the figures being- 
used to designate the number of the boring)-spout forth 
as white foaming liquids, only thirty-two feet apart, high 
above the surface of the ground, and are connected with 
five bath houses, four in the immediate neighborhood and 
a fifth (bath house No. 4) which provides only simple IN DISEASES OF THE HEART. 
3 
saline baths from spring No. 7 outside the park at a little 
distance from the others. 
Bath house No. 5, opened in 1892, is much superior to 
the rest, and is a handsome building completely furnished 
with every requisite. At the present time there are in the 
whole establishment at Nauheim one hundred and ninety- 
six bathrooms with two hundred and four tubs. The tubs 
are of wood, painted, which has been found to be the most 
satisfactory material, and are of large size, so that when a 
tub is filled the body of the bather is entirely immersed up 
to the neck, and the pressure of the water on its surface is 
very considerable. Everything connected with the baths, 
which are under government control, is admirably system- 
atized, and the attendants are well fitted by long experience 
for the discharge of their duties. 
Drinking the waters plays but a secondary part at 
Nauheim, but their internal use is of some value in gouty 
conditions and disorders of the liver, the Kurbrunnen diluted 
being said to resemble the Ragoczy spring of Kissingen, and 
the Karlsbrunnen, the Elizabeth Brunnen of Homburg. The 
Ludwigsbrunnen is also used as a table water. The Schwal- 
heim spring, two miles distant, yields a ferruginous water 
containing carbonic acid. 
The first bath house at Nauheim was opened in 1835, 
and the baths have been used for many years with advan- 
tage in gout, rheumatism, rickets, and so-called scrofulous 
diseases, and have acquired a well-merited repute in the 
treatment of locomotor ataxia and other diseases of the 
spinal cord ; but F. W. Beneke, professor of general pathol- 
ogy and pathological anatomy at Marburg-a highly 
picturesque university town an hour by rail north of Nau- 
heim-was the first to show, contrary to then prevailing- 
views, not only that patients with heart disease, more espe- 
cially those recovering from acute rheumatism, can bear 4 
THE BATHS OF NAUHEIM 
balneological treatment, but that they are actually benefited 
by such a course. Beneke, who was physician to the Nau- 
heim baths from 1857 to 1866, and continued to visit them 
up to his death, in 1883, wrote several articles upon the 
effects he had observed there, the earliest of which ap- 
peared in 1859. After the publication of his more impor- 
tant paper in 1872 (6) patients with heart disease began to 
frequent Nauheim in greater numbers, and, following the 
lines of investigation suggested by his observations, the 
baths began to be studied more closely by other physicians. 
In 1880 Dr. August Schott, who had been making inde- 
pendent studies since 1871, published a paper (20) by far 
the most important and exhaustive of any that had yet ap- 
peared, and the first to do full justice to the remarkable 
effect of the baths upon the heart. Numerous articles 
relating to the same and allied subjects have since been 
written by himself and his brother, Dr. Theodor Schott, 
and to their joint labors the present celebrity of Nauheim 
is largely due. 
Within the last ten years the annual number of visitors 
during the season, a large proportion of whom are heart 
patients, has more than doubled, amounting to over twelve 
thousand in 1895. 
The effect of the Nauheim baths, as proved by repeated 
observations, is to regulate the action and strengthen and 
improve the nutrition of the diseased heart, whether its 
inability to properly perform its functions depends upon 
valvular lesions and their consequences or upon malnutri- 
tion or disease of the cardiac muscular substance. These 
results are chiefly due to the chloride of sodium and the 
more irritating chloride of calcium, the former of which 
constitutes about four fifths of the solid constituents, and 
to the free carbonic acid, which they are said to contain 
in larger amount than almost any other baths in Ger- IN DISEASES OF THE HEART. 
5 
many. They contain, moreover, a considerable percentage 
of iron, to which may also be attributed a tonic influence. 
The most powerful though more temporary stimulation, as 
proved experimentally, is caused by the carbonic acid. By 
means of the action of these saline and gaseous contents of 
the bath upon the terminal branches of the sensory nerves 
of the skin an impression is made upon the cardiac and 
vaso-motor centres, by which the heart is reflexly stimu- 
lated to more powerful and vigorous contraction and the 
arteries are more completely filled, and at the same time the 
cutaneous vessels dilate, peripheral resistance is lessened, 
and the whole circulation is rendered freer and more active, 
while metabolism is promoted and a marked influence ex- 
erted upon the trophic centres, as must be inferred from 
the striking evidences of improvement in the bodily nutri- 
tion in general, and in that of the heart in particular, and 
the persistence and even increase of the good effects long 
after the patient has completed the course. 
The immediate objective results of the baths are as fol- 
lows: Examination of the pulse, confirmed by sphygmo- 
graphic tracings and the sphygmomanometer, shows it to 
be made slower, stronger, and of increased volume, the 
cardiac sounds become more distinct, and in cases of dila- 
tation an unmistakable contraction of the heart, demon- 
strable by percussion and by the change in the position of 
the apex beat, is observed. This contraction is most notice- 
able in the transverse diameter of the heart, and takes place 
to little or no extent when the enlargement is solely com- 
pensatory, as in many cases of organic mitral and aortic re- 
gurgitation. Dr. Bezly Thorne, however, affirms that there 
is a diminution in the area of cardiac dullness, as measured 
in the oblique transverse diameter, of a third to about half 
an inch even in the healthy heart. The respiration be- 
comes easy, and is slower and deeper, and there is usually 6 
THE BATHS OF NAUHEIM 
increased action of the kidneys. Subjectively, a sense of 
weight and oppression on the chest, greater than in an ordi- 
nary bath, is at first experienced, which quickly passes off; 
the skin soon becomes warm, and tingling, accompanied 
with redness, is felt in its more sensitive parts. Afterward, 
the patient feels invigorated, and is generally conscious of 
a sense of drowsiness. 
Baths capable of producing these effects are not the 
monopoly of Nauheim; it has not been denied that anal- 
ogous results may be obtained from other natural mineral 
baths of similar composition, and by natural carbonated 
iron springs, or even by artificially prepared baths; but 
the peculiar advantages of Nauheim are the following: 
1. It possesses an abundant flow of water from two 
springs, containing different proportions of the needful 
salts and carbonic acid, either of which can be used singly, 
or mixed together in every proportion. 
2. The natural temperatures of the springs (No. 7, 
88'88° F.; No. 12, 95*5° F.) -a feature of great impor- 
tance- are among those found most applicable to heart pa- 
tients, so that more or less complex arrangements for heat- 
ing the baths, which, moreover, would drive off a portion of 
the carbonic acid, are unnecessary. At Nauheim, when it is 
desired to raise the temperature, an inappreciable amount 
of hot water is added; to cool the baths, lumps of ice are 
employed. 
3. The presence of an unusually large amount of car- 
bonic acid in the waters. 
4. The possibility of providing a steady flow of the 
spring water, in and out of the bath (JStrombad), at a suit- 
able and constant temperature. 
5. The Nauheim physicians are specialists in diseases 
of the heart; the employment of mineral baths for the 
treatment of heart disease originated at Nauheim, and no- IX DISEASES OF THE HEART. 
7 
where else is their proper use as yet so thoroughly under- 
stood. 
Other baths in Germany where good results are like- 
wise to be obtained, some of which have been reported, 
are, among the saline, those of Kissingen and Rehme-Oeyn- 
hausen, and of the iron waters, Cudowa, Pyrmont, and 
Schwalbach. In our own country there is every reason to 
believe that the springs of Ballston and Saratoga are in 
many respects adapted for successfully conducting the bal- 
neological treatment of heart disease, on account of the 
large quantities of chloride of sodium and carbonic acid 
which they contain in various proportions, so that as at 
Nauheim different springs could be used, according to the 
needs of each case. The only apparent objections are the 
presence of unnecessarily large amounts of carbonates of 
the alkaline earths, the absence of chloride of calcium, and 
the necessity of artificially heating the baths, none of which, 
however, constitute insurmountable obstacles. 
Artificial baths may be prepared by dissolving the 
requisite percentage of required salts, or, as Dr. John 
Broadbent points out, by the use of sea water, which con- 
tains 2'7 per cent, of chloride of sodium, and by adding 
for the production of carbonic acid suitable proportions of 
commercial muriatic acid and bicarbonate of sodium or 
chalk, or, as has been suggested, a mixture of the bicarbon- 
ate and bisulphate of sodium. The gas, however, when 
thus evolved, escapes more rapidly than it does from the 
natural baths. 
Good results may undoubtedly be obtained in this way, 
and such baths have been employed by Dr. Bezly Thorne 
in London and by Dr. Babcock in Chicago, as well as in 
the Middlesex Hospital, with success ; but the greater free- 
dom from counteracting injurious conditions to be had at 
a spa, and the various advantageous mental and hygienic 8 
THE BATHS OF NAUHEIM 
influences to which the patient is there subjected, are suffi- 
cient reasons, even allowing the artificial baths to be as 
effective as the natural waters, why the results obtained at 
Nauheim are more striking than those reported from the 
cities. Mineral springs in the country, especially when 
possessing a part of the requirements, offer more promising 
opportunities, and provision has been or is being made at 
Harrogate and various places in England for carrying out 
the treatment. 
In administering the Nauheim baths to patients with 
heart disease several varieties are employed, for when the 
effect of one kind of bath becomes less and less marked, 
owing to the nervous system gradually becoming habitu- 
ated, a fresh stimulus is imparted by changing to a stronger 
bath, and thus a longer course can be taken than would 
otherwise be advantageous. The method employed by Dr. 
Theodor Schott, which is in the main practised by the 
other Nauheim physicians, is the following: The first bath 
ordered (thermal Soolbad) is supplied by the water taken 
from the receiving basins, from which by exposure to the 
air a large part of the carbonic acid has escaped, and a 
considerable proportion of iron and salts has been precipi- 
tated, so that it is of a muddy color and contains few 
or no bubbles of gas. No. 7 is the spring usually first 
employed, as it contains the smaller proportion of salts, 
2T8 per cent, of chloride of sodium and 0T7 of chloride 
of calcium. Dr. Schott recommends for some cases, at the 
beginning of treatment, baths containing only one per cent, 
of chloride of sodium and 0'1 per cent, of chloride of cal- 
cium. The natural temperature is 88 8° F., but this at 
first is raised to one varying from 92° to 95° F. Tempera- 
tures above that of No. 12 spring, 95'5 F., are not suitable 
for heart patients. The duration of the bath, at first six to 
eight minutes, is gradually lengthened every few days, one IN DISEASES OF THE HEART. 
9 
minute at a time, while at intervals the temperature is low- 
ered about one degree (half a degree centigrade). 
At first every second or third day, afterward every 
fourth or fifth, the bath is omitted. The percentage of 
salts is now gradually increased, which may be done at 
first by mixing the waters of Nos. 7 and 12, but is usually 
accomplished by adding one litre of Nauheim " Mutter- 
laugev' (mother-lye)-the uncrystallizable liquid left behind 
in the manufacture of salt-which is subsequently increased 
to two and three litres, or occasionally even more. The 
main ingredient of this is chloride of calcium, which may 
be raised eventually in the bath to the amount of 0'5 per 
cent. When the proportion of salts is thus rendered suffi- 
ciently large, the temperature by this time having been 
lowered several degrees, and the duration extended to not 
more than twenty minutes, the patient is ready to continue 
treatment by a course of Sprudel baths from either No. 7 or 
No. 12, the former containing the greater amount of car- 
bonic acid, the latter of salts. These differ from the others 
in being supplied with water direct from the springs, before 
it has undergone the action of the air, so that it appears of 
crystal clearness and filled with sparkling bubbles of car- 
bonic acid, which it retains in undiminished quantity. 
They are likewise at first taken warm, usually at their natural 
temperatures, and for a short time-about eight minutes 
-and as they are continued the temperature is lowered 
in the same cautious way and the duration similarly pro- 
longed. The saline contents may also be increased by suc- 
cessive additions of " Mutterlauge." In consequence of 
the powerful excitation of the cutaneous circulation by the 
carbonic acid, which creates an agreeable feeling of warmth, 
the temperature can be lowered to a degree which could 
not be otherwise tolerated, but is seldom if ever reduced 
below 80° F. The final, most powerful form of stimulation 10 
THE BATHS OF NAUHEIM 
is the Sprudelstrombad, in which the supply and overflow 
pipes of the bath tub are left open, so that in addition to 
the fresh supplies of carbonic acid, the shock of the run- 
ning water against the body is experienced. These are not 
given to many patients in their first season at Nauheim. 
During the entire period of the administration of the baths 
their effect is watched with the utmost care, and the char- 
acter of the respiration, condition of the pulse, and sounds 
of the heart carefully noted; if, after half a minute in the 
bath and the maintenance of a perfectly quiet attitude, a 
decided sense of cold persists or afterward recurs, the tem- 
perature is too low or the bath is in other respects unsuit- 
able. In fact, if improperly administered, especially if too 
cold or of too long duration, the baths may not only pro- 
duce no good effect, but may prove positively injurious 
and even dangerous to the patient by increasing instead of 
diminishing any existing dilatation, and if the Nauheim 
treatment ever becomes too popularized, and is conducted 
by incompetent persons, there is much reason to fear dis- 
astrous results. 
After each bath the patient, having been well rubbed, 
is usually directed to lie down for about an hour. The 
food and mode of life are regulated in accordance with the 
usual requirements for heart patients and the physician's 
orders. No cardiac tonics are ordinarily given, except in 
extreme cases at thebeginning of the course. An ordinary 
course of baths at Nauheim is estimated at about twenty- 
one or twenty-five, extending over a period of four or five 
weeks. This period is sometimes much lengthened, and not 
infrequently two courses, separated by a considerable inter- 
val, are taken in one summer. After the completion of the 
course, the patient is recommended before returning to the 
cares of ordinary life to take an "after-cure " by a sojourn 
of a few weeks at some quiet, healthful resort possessing a IN DISEASES OF THE HEART. 
11 
moderately stimulating climate, such as places in the Black 
Forest, the mountains of North Germany, or localities 
in Switzerland not exceeding three thousand feet in alti- 
tude. The beneficial results of the action of the baths 
are further greatly increased by means of a series of 
gymnastic exercises, capable also, when used alone, of 
powerfully affecting the heart and circulation-the so- 
called resisted movements-the Widerstandsqymnastik of 
P. II. Ling. 
The late Dr. August Schott (who died in 1886) deserves 
the credit of having brought before the profession their pe- 
culiar value, and of having by careful study devised the most 
suitable methods of their application. Together with his 
brother, Dr. Theodor Schott, he showed that they formed 
a most important adjuvant to the baths, and the combined 
systematic employment of these two remarkable agencies is 
now usually referred to as " the Schott methods." These 
exercises are intended to bring into action successively most 
of the voluntary muscles, and consist of alternate move- 
ments of flexion and extension, abduction, adduction, and 
rotation of the limbs and trunk, such as we are familiar 
with in ordinary calisthenic exercises or home gymnastics. 
Against these motions a resistance, graduated in each case 
to the capacities of the patient, is offered by the physician 
or a trained attendant. By the interposition of this resist- 
ance the muscular contractions are made more complete 
and energetic, as well as of sufficient slowness and regulari- 
ty, which last is a matter of prime importance. 
The exercises recommended by Dr. A. Schott are as 
follows: 
1. Movements of the extended arms in three directions. 
(a) From the ordinary position by the sides of the body 
forward and upward until they reach the temples, and back 
again. 12 
THE BATHS OF NAUHEIM 
(6) From the same position laterally outward and up- 
ward to the temples, and back. 
(c) From the horizontal position, with the palms of the 
hands meeting in front of the body, as far apart as possible, 
and back. 
Rotation of the extended arms about their axes as fully 
as possible, causing pronation and supination. 
2. For the elbow, wrist, and finger joints the natural 
flexions and extensions; radial and ulnar abduction and 
adduction. 
3. (a) Flexion of the trunk forward, from a little be- 
yond the erect position, and back. 
(6) Lateral flexions of the trunk to right and left, and 
back. 
(c) Rotations of the trunk on its axis to right and left, 
and back. 
4. Movements of each extended leg forward and up- 
ward, outward and upward, backward and upward, and 
back. 
5. The natural flexions and extensions of knee and ankle 
joints. 
A description of these movements and the methods of 
applying the resistance in full detail, with illustrations, will 
be found in Dr. Bezly Thorne's larger work (39). 
The resistance is always made by the attendant with 
the palm of the hand in the direction exactly opposite to 
that of the movement, and in applying it to the wrist and 
ankle these parts are placed in the fork formed by separat- 
ing the thumb and fingers; but a limb is never actually 
grasped, lest support, rather than resistance, should be 
made. 
The degree of force employed should be as much as the 
patient can overcome without the slightest discomfort, and 
should be so uniformly applied as to enable him to perform IN DISEASES OF THE HEART. 
13 
the movements slowly, evenly, and without jerks. lie must 
be able to breathe quietly, and the mouth and alae nasi must 
be watched carefully, so that at the slightest indication of 
loss of breath a pause may be made. Some of the move- 
ments may be omitted according to circumstances; the 
most trying to the patient are the elevation of the arms 
above the head and the trunk exercises. The limbs are not 
allowed by the attendant to fall suddenly after the comple- 
tion of a movement, and a considerable interval of time is 
always allowed between each one, and is prolonged if the 
patient seems at all fatigued. The clothing should, of 
course, be perfectly loose and easy. The exercises are usu- 
ally given for about half an hour, the series being gone 
over twice in that time, but they are often employed for 
shorter or longer periods. 
Dr. Schott has also devised a scheme by which the serv- 
ices of the attendant may sometimes be dispensed with. 
In carrying out these self resisted exercises (Selbsthem- 
mungsgymnastik), as they are called, the patient endeavors, 
as it were, to resist his own movements by partially con- 
tracting at the same time the antagonistic muscles. This 
demands some intelligence on his part, and it would be 
often unsafe to allow its employment. 
The action of these exercises is to produce an effect 
similar in many respects to that caused by the baths; the 
cold extremities become warm, the sense of oppression in 
the chest is relieved, and the breathing deepened. The 
pulse usually becomes fuller, stronger, and slower, and an 
immediate diminution in the area of dullness of the dilated 
heart, not due to increased overlapping by the lung, with a 
simultaneous lessening of the dimensions of the passively 
congested liver, have been frequently demonstrated. The 
effect is often very speedy and striking; an attack of car- 
diac asthma, according to Dr. A. Schott, which would other- 14 
THE BATHS OF NAUHEIM 
wise continue for hours, may in a few minutes be charmed, 
as it were, away, and an extreme dilatation be temporarily 
so completely dispelled that hardly a vestige remains. 
The physiological explanation of the effects of these 
exercises is not altogether easy. It has been suggested by 
Dr. Schott that what the baths effect through the sensory 
nerves, the exercises produce through the motor nerves. 
Dr. Bezly Thorne (39) says : " The motor nerves, called into 
orderly, regulated, and, above all, not exhausting activity, 
seem to exercise centripetal and reflex influences similar to 
those which are brought into action by the baths through 
the nerves of sensation." 
Although there is an undoubted relation existing be- 
tween the activity of a motor nerve and the nutrition of its 
corresponding centre, we can hardly look upon it as exert- 
ing centripetal influences in the sense that a sensory nerve 
does. It may be admitted, however, that the action of the 
motor nerves initiates a series of complex processes in mus- 
cle, blood, and nerve by which the heart is reflexly stimu- 
lated, though the exact details are difficult to trace. 
Sir William Broadbent (9), while not denying the pos- 
sibility of a nervous influence, is of the opinion that the 
most important factor is the physiological dilatation of the 
capillaries in the exercised muscles, which is continued into 
the arterioles and arteries to allow of the additional supply 
of blood. At the same time, from the character of the ex- 
ercises, the compression of the veins which drives on the 
venous blood to the right heart and gives rise to the dysp- 
noea attending exertion does not take place. There is thus 
a transfer of blood from the venous to the arterial system, 
which is the exact reverse of the tendency attending most 
forms of heart disease, and so peripheral resistance is less- 
ened. He admits that diminished peripheral resistance is 
not the only factor, as shown by the fact that the action IN DISEASES OF THE HEART. 
15 
of the heart is rendered slower instead of being accel- 
erated. 
The whole subject is thus tersely summed up by Dr. 
Theodor Schott: " Unsystematic exercises constitute a 
heart-weakening, systematic exercises, on the contrary, a 
heart-strengthening treatment." 
The question of the relative value of baths and exer- 
cises in each particular case can not be answered with ex- 
actness, on account of the varying length of time and de- 
gree of force with which the latter are tolerated; but 
ordinarily the baths which seem to affect the cardiac nutri- 
tion more profoundly are more applicable to severe cases, 
and their beneficial effect at first is decidedly the greater 
and more lasting, a result attributed by Dr. Schott to the 
retention in the skin of the salts of the bath, which pass by 
imbibition through the epidermis to the corium and con- 
tinue to exert their action for a considerable period. 
Later in the course, when the heart has gained strength and 
the exercises can be repeated with greater force, frequency, 
and duration, the reverse may be the case. Taken to- 
gether, the two agencies, as Dr. Bezly Thorne remarks, are 
capable of producing effects which throw the action of 
drugs completely into the shade. 
Other forms of exercise known to benefit a weakened 
heart, such as the method of Oertel, the so-called Terraln- 
kur, and the movements by the aid of the Zander machines, 
which are especially advocated by Dr. Groedel, are em- 
ployed at Nauheim, where a well equipped Zander institute 
has been in operation for the last three seasons. The 
Terrain-kur, however, is too severe a method for many pa- 
tients who are yet able to undergo with profit the slow, 
easy, and systematic motions of the resisted exercises, al- 
though it may be used with advantage when the heart has 
gained sufficient power. By the Zander machines the 16 
THE BATHS OF NAUHEIM 
force can be adjusted with the utmost exactness, but can 
not be so readily altered, while the attendant applying 
manual resistance can instantly vary the amount of force, 
according to the changing sensations of the patient and the 
effects produced. 
Let us now consider in some detail what is to be ex- 
pected from the Nauheim treatment. Although the baths 
have been resorted to by patients with heart disease for 
many years in steadily and of late rapidly increasing 
numbers, the effects obtained there have been but slowly 
and imperfectly recognized even in Germany. The French, 
for more or less obvious reasons, have hitherto almost to- 
tally ignored them. In this country the papers of Dr. Theo- 
dor Schott (29) and Dr. Babcock (1), that have appeared 
in our own journals, have not as yet created the impression 
they should have done. Moreover, but brief and casual 
references are to be found in the text-books. It may per- 
haps be thought, therefore, that the advantages of the 
Schott treatment are yet somewhat problematical, and that 
there is still room for differences of opinion. This is by 
no means the case. The conclusions reached were not ar- 
rived at hastily. It had for some years been gradually be- 
coming evident that the influence of the baths was decid- 
edly tonic, even- in cases of heart disease, but it was not 
until after their effect upon a large number of patients 
had been carefully studied that Dr. A. Schott ventured to 
affirm that they exerted not merely a general tonic influ- 
ence, but constituted, like digitalis, " a tonic of the first 
order for the enfeebled heart." This remarkable statement 
was received with considerable incredulity-for example, by 
Leichtenstern (von Ziemssen's Handbuch der allgem. Thera- 
pie, Bd. ii, Theil 1, p. 262)-but the further observations of 
theDrs. Schott (now amounting to over five thousand cases), 
Dr. Groedel, Dr. Bode, and other Nauheim physicians have IN DISEASES OF THE HEART. 
17 
proved its absolute accuracy, which has been further cor- 
roborated by foreign physicians who have examined into the 
question on the spot, among whom are such distinguished 
members of the profession as Professor von Jurgensen, of 
Tubingen, Dr. Pawinski, of Warsaw, Dr. Moeller, of Brus- 
sels, and numerous well-known English medical men. Dr. 
II. N. Ileineman, of New York, made many careful studies 
during the past summer at Nauheim, which he has repeat- 
edly visited, but beyond a brief notice in a paper published 
several years ago {Medical Record, March, 189.0), I am not 
aware that he has yet published his own observations. 
Dr. Theodor Schott has frequently demonstrated the im- 
mediate alteration in the deep cardiac dullness after both 
baths and exercises in patients with dilated hearts to the 
satisfaction of physicians coming from a distance to visit 
Nauheim and to learn his methods. 
In Great Britain, owing chiefly to the exertions of Dr. 
Bezly Thorne, the Schott methods, first made known there 
in 1891, have within the last year or two obtained full rec- 
ognition, and created an increasing interest, so that the ap- 
proaching summer will see large numbers of English has- 
tening to Nauheim. It is now a mere question of time 
when their value will be universally admitted. 
The effect of the treatment, then, being to powerfully 
affect the nutrition and increase the strength of the heart, it 
may be expected to produce the following results: In fresh 
endocarditis after rheumatism the baths promote to a high 
degree the absorption of the inflammatory products and 
offer hopeful prospects of a more or less complete cure. 
In chronic valvular disease, where there is serious damage 
to the valve segments, they can not ordinarily produce the 
slightest effect upon the injured valve itself, those mur- 
murs which disappear during the course being due to re- 
laxation of the orifices or want of tone in the papillary 18 
THE BATHS OF NAUHEIM 
muscks. Dr. Groedel, of Nauheim, however, states that he 
has met with a very few remarkable cases presenting evi- 
dences of fully developed valvular disease which have been 
cured at Nauheim, one of which is mentioned in Professor 
Eichhorst's Handbuch der speciellen Pathologic und Thera- 
pie, fifth edition, vol. i, p. 56. This patient had all the 
signs of pronounced mitral insufficiency, and these so en- 
tirely disappeared after two seasons at Nauheim that he 
was accepted as sound by a very strict life-insurance com- 
pany. At the end of ten years there was still no trace of 
the disease. Although we can not expect that seriously 
injured valves should be restored to their normal condition, 
failure of compensation resulting therefrom is signally 
benefited, and it is in those cases especially in which digi- 
talis is not tolerated or has not proved useful that the 
results are so astonishing. It is well known that in aortic 
regurgitation digitalis is not always beneficial. Good re- 
sults are secured at Nauheim, however strange it may at 
first appear, in lack of compensation both from aortic and 
from mitral disease, as well as in cases of combined disease 
of both valves and in many instances of patent foramen 
ovale. The gradual influence exerted upon the nutrition 
of the heart, without the other accompanying undesirable 
effects which are often a cause for the failure of medicinal 
treatment, offers an immense advantage. 
In weak hearts without serious organic lesion, from 
anaemia, chlorosis, and convalescence from acute diseases, 
and the myocardial affections resulting from influenza, 
most excellent results are obtained, particularly in young 
subjects, as well as in cases of heart strain and dilatation 
due to overexertion. In the chronic sclerotic changes 
(arterio-sclerosis, chronic myocarditis) of heart and ves- 
sels and fatty degeneration, with or without dilatation, 
so frequent in persons of advancing years, of which the IN DISEASES OF THE HEART. 
19 
ordinary treatment is usually palliative, the benefit to be 
derived is naturally more uncertain and generally requires 
long and persistent treatment. Some of the most remark- 
able results of the Schott methods, however, have been 
attained in apparently otherwise hopeless cases, and even 
patients suffering from angina pectoris have been practi- 
cally cured at Nauheim. It is easy to say with Professor 
Huchard (Traite clinique des maladies du coeur et des 
vaisseaux, second edition, p. 420) that these are cases of 
pseudo-angina, but there is no doubt that cases presenting 
all the clinical features of true angina pectoris due to or- 
ganic disease have been relieved at Nauheim. It would, of 
course, be absurd to state that such irreparable lesions as 
calcified coronary arteries or advanced fatty degeneration, 
which are often associated with the disease, could be 
affected by the Nauheim treatment, and, while many cases 
of angina pectoris are hopeless under any circumstances, 
yet the effect of the Nauheim baths upon the cardiac nu- 
trition is so remarkable that where the lesions are not too 
far advanced or only commencing the results of the treat- 
ment are eminently gratifying. The fact is, as Balfour 
well points out (The Senile Heart, pp. 116 et seq.), that the 
expression pseudo-angina is often misleading, and should 
not be applied to cases presenting symptoms identical with 
those of true angina, merely because the heart lesion hap- 
pens to be curable. Such cases it is often impossible to 
distinguish from the incurable ones, and Balfour conse- 
quently expresses himself in regard to the prognosis that 
this is often more hopeful than we should at first be led to 
suppose. Tn Dr. Th. Schott's paper (27) four striking cases 
are given as illustrative of his large experience. 
The results in cases of heart disease dependent upon or 
complicated with disease of the kidney are less encourag- 
ing and more variable, but albuminuria due merely to sec 20 
THE BATHS OF NAUHEIM 
ondary renal congestion may altogether disappear. Cases 
of functional nervous disturbance of the heart are usually, 
but not always, benefited. 
The contraindications to the Nauheim treatment are 
advanced arterio-sclerosis and aortic aneurysm. Patients 
with the latter affection have used the baths with some 
alleviation of symptoms, but on account of the danger of 
raising the blood pressure these must be employed with the 
greatest caution. Many very serious cases of heart disease 
come to Nauheim, and, as is only to be expected, some 
deaths occasionally take place during the season ; but such is 
the care taken by the local physicians, who write their 
orders with exact directions, that fatal accidents directly 
attributable to the baths are practically unknown. Groedel 
states that during a practice of many years at Nauheim he 
has never had a case of sudden death during the bath, al- 
though he has known of two cases of apoplexy which 
occurred during the exertion of dressing. 
As to the exact length of time required for a cure, it is, 
of course, impossible to say; improvement is usually ob- 
served after a week or two, and some patients are relieved 
by a single course, but many others require a much longer 
period, and there are comparatively few who are ill enough 
to undertake a long journey to Nauheim in search of relief 
for whom it is not advisable that they should return for 
another or several successive seasons, while in some des- 
perate cases the treatment will necessarily fail. 
During a stay of a month at Nauheim last summer I 
was enabled to acquaint myself with the details of the ad- 
ministration of baths and exercises, to note their effect upon 
the pulse, and to personally test the former, including the 
Sprudelstrombad. I had also time to become familiar with 
the general life of the place and to learn how universally it 
was recognized that good results were to be expected in IN DISEASES OF THE HEART. 
21 
patients with heart disease, who were undergoing treatment 
there in large numbers. 
The individual cases I had opportunity to examine were 
few in number, but several were such as to afford convinc- 
ing illustrations of the value of the treatment, if any such 
were needed after the carefully reported cases that are 
already to be found recorded in various publications. 
Case I.-Captain von H., aged forty-six years, seen by the 
kindness of Dr. Schott. The patient, a large, strongly built, 
fine-looking man, had suffered repeatedly from rheumatism, 
his first attack having occurred many years before. He was 
found to have aortic regurgitation, and, having obtained but 
little relief from his symptoms, and not being able to bear 
digitalis well, came to Nauheim in 1892 in very bad condi- 
tion, as he stated, with intermittent pulse, scarcely able to 
walk more than a few steps, and entirely incapacitated for 
the discharge of his duties, but without dropsy. When I 
saw him, on July 24th, he was just completing his fourth 
course at Nauheim. 
The treatment the first year began with thermal baths of 
very short duration, and each successive year more powerful 
ones had been taken, so that the present season he had been 
taking Sprudel baths entirely. With the baths the exercises 
had been administered, as he thought, with marked benefit. 
On examination I found the heart enlarged, with apex beat 
diffused, but quite devoid of heaving character. No notice- 
able pulsation in the arteries of the neck. There was a distinct 
diastolic murmur in the aortic area, with the characteristic 
pulse of aortic regurgitation, which was, however, quiet and 
regular. He complained still of slight prsecordial pain, but 
since he had been coming to Nauheim had been relieved of 
his former symptoms and enabled to take exercise, sometimes 
of a very vigorous character. He presented a healthful ap- 
pearance and compensation was practically perfect. 
Case II.-Mr. C., aged fifty-three years, a native of Den- 
mark, and a resident of British India, a sufferer from angina 
pectoris, for seeing whom I am also indebted to Dr. Schott. 22 
THE BATHS OF NAUHEIM 
The patient, a stout, rather short man of sallow complexion, 
had experienced attacks of varying severity, sometimes slight, 
sometimes very extreme, for two years and a half. The pain 
extended down the left arm, which it had rendered numb and 
helpless. Nitroglycerin and nitrite of amyl had been used 
with good effect, but had proved merely palliative. The pa- 
tient was also suffering with a congested liver. He had been 
recommended, I believe, by Dr. T. Lauder Brunton to go to 
Nauheim. He began treatment on the 31st of May under Dr. 
Schott, who considered his heart to be affected with incipient 
fatty degeneration, accompanied with some degree of dilata- 
tion. Beginning with a thermal bath of 32'5° C. (90'5° F.) 
temperature and eight minutes' duration, these were continued 
until fourteen had been taken, the duration gradually pro- 
longed up to seventeen minutes' and the temperature reduced 
1° C. Beginning with the sixth bath, one litre of " Mutter- 
lauge" was added, which was increased up to three litres. 
On June 19th Sprudel baths were begun, of at first eight 
minutes' duration, which were finally prolonged to twenty 
minutes, and the temperature reduced as low as 28° 0. 
(82-4° F.). 
From the 23d of July, for the remainder of the course, the 
Sprudelstrombad No. 7 (temperature, 88'8° F.) was taken, at 
first for eight minutes, afterward for gradually lengthened 
periods. Every fourth or fifth day during the course, or oc- 
casionally the third day, the bath was omitted. In all more 
than forty baths were taken. The patient commenced to 
take the exercises about two weeks after beginning the baths, 
and also used one of the drinking springs for its effect upon 
the liver. After the first week at Nauheim he was able to 
abandon the use of nitroglycerin, and at the time of my inter- 
view with him (July 26th) had had no pain for a couple of 
weeks. On examination the apex beat could not be felt, but 
the heart sounds were all normal, though somewhat weak. 
The heart dullness, as well as could be ascertained in so stout 
a person, was normal. Pulse regular, rather weak, and easily 
excited. Superficial arteries not sclerosed. The liver had 
regained its normal size. The patient left in excellent condi- IN DISEASES OF THE HEART. 
23 
tion on August 8th in a cheerful frame of mind, greatly 
impressed by his personal experience of both baths and ex- 
ercises. 
This remarkable case was also examined with interest by 
several other physicians stopping in Nauheim at the time. 
Case III.-Mrs X., a patient in middle life, for more than 
three years suffering from a badly nourished and overstrained 
heart. 
The symptoms in their most extreme form consisted in 
inability to make the slightest exertion, with occasional dan- 
gerous attacks of syncope, necessitating subsequent entire 
rest for weeks and even for months at a time. Digestive 
power was very feeble, and medicinal treatment was not 
well tolerated and was comparatively ineffective. On arriv- 
ing at Nauheim she was just beginning to improve after a 
series of alarming attacks of heart failure. Examination 
showed the left ventricle dilated and the apex beat barely 
perceptible in the nipple, line or somewhat outside. Cardiac 
sounds very feeble, but clear (at times a faint systolic mur- 
mur had been noted), and pulse excessively weak. Com- 
plexion pale. The patient at this time could walk with difficulty 
for about a hundred yards on a level. Treatment began 
July 13th with a thermal bath from spring No. 7; tempera- 
ture, 34° C. (93'2° F.); duration, eight minutes; July 14th, 
bath of nine minutes ; July 15th, no bath ; July 16th, bath of 
ten minutes; July 17th, bath of eleven minutes; July 18th, 
bath of twelve minutes; July 19th, no bath. On July 18th 
patient felt distinctly better, and apex beat had receded about 
half an inch nearer to median line. July 19th: Began the 
exercises given by a trained operator with very gentle resist- 
ance for about half an hour, including pauses. The effect 
was good, causing slight increase of warmth and deepening 
the breathing. The course of baths was continued, one litre 
of " Mutterlauge'1'1 being added, and the temperature reduced 
0'5° C. on July 20th, and by August 7th three litres had been 
added, the temperature lowered to 32'5° C., and the time ex- 
tended to twenty minutes. At the beginning of August the 
patient's progress was unfortunately impeded for a few days 24 
THE BATHS OF NAUHEIM 
by an acute illness accompanied with moderate fever, so that 
three baths which would otherwise have been taken were 
omitted. The effect of the last baths, cooler and of long 
duration, was not so striking as that of the previous ones, the 
patient experiencing some sensations of fatigue and chilli- 
ness. August 9th: Sprudel baths of No. 12, of natural 
warmth (95'5° F.), with the full amount of carbonic acid, 
were commenced, beginning with a length of eight minutes, 
which had been extended to fifteen when the last was taken. 
These Sprudel baths seemed to impart to the patient a fresh 
impulse and improvement was again rapid. After a stay at 
Nauheim of nearly six weeks, during which about fifteen sim- 
ple thermal baths and nine Sprudel baths were taken, the 
patient left, not cured, but in a greatly improved condition, 
still unable to walk upstairs without support, but able to 
walk comfortably on a level more than half a mile, as well as 
to exert herself in ways previously impossible, a striking and 
satisfactory result considering her .wretched condition on 
arrival. 
I was also able to closely watch the treatment and its 
effects in two patients, over sixty years of age, in whom the 
symptoms were not very urgent, and, although some im- 
provement was evidently effected, the results, as might have 
been expected in such cases in so short a time, were not 
very striking. 
The first, in whose somewhat enlarged heart systolic mur- 
murs at base and apex, attributed to sclerotic changes in the 
valves, were audible, and who suffered with attacks of angi- 
na, not of great severity, but sufficient to occasionally neces- 
sitate stopping short in the street, shortness of breath, feeble 
and sometimes intermittent pulse, and functional disorder of 
the liver, but who was able usually to take moderate walking 
exercise, took fourteen thermal baths of No. 7 and seven 
Sprudel, No. 7, beginning w ith a temperature of 32'5° C. (OO'S0 
F.) and a duration of ten minutes. The gymnastic exercises 
were also given for half an hour every day, within a day or IN DISEASES OF THE HEART. 
25 
two after commencing the baths. They improved the breath- 
ing, giving a comfortable sense of relief in the chest, but did 
not slow the pulse more than a few beats. When lying down 
immediately afterward, the pulse would sometimes intermit 
for a short time, but the general effect was evidently benefi- 
cial. I examined this patient with a view to ascertaining any 
immediate diminution in the area of cardiac dullness after a 
thermal bath and after the exercises, but was unable to satisfy 
myself that there was any decided alteration. On leaving, 
the patient had less frequent attacks of pain and had other- 
wise somewhat improved. The good effects of the treatment 
seemed to be felt even more after leaving Nauheim. The car- 
diac murmurs still persisted. 
The second of these patients, subject to gout and rheuma- 
tism, and possessing a weak and badly nourished heart, was 
affected with moderate tachycardia without other positive evi- 
dences of disease, the pulse-rate reaching 100 even when the 
patient was quietly resting, and giddiness was complained of 
on lying down at night. The patient, who was anaemic, was 
given a preparation of iron, and, beginning with a tempera- 
ture of 34° C. (93'2° F.) and length of eight minutes, took 
sixteen thermal baths of No. 7 and six Sprudel baths of No. 
12. A few days after beginning the baths the exercises were 
commenced and given for half an hour daily and were well 
tolerated, the pulse-rate immediately after either remaining 
about the same or rendered less rapid. At the completion of 
the course, though the frequency of the pulse was not mate- 
rially diminished, its character was improved; the heart was 
evidently strengthened, the giddiness relieved, and, in the 
patient's own opinion, good had been accomplished. 
The following case, among those reported by Dr. Bezly 
Thorne (38), is of so much interest that I venture to quote 
the greater part of his account: 
A woman, fifty-two years of age at the present time 
(1894), and the subject of inveterate lithaamic tendencies, 
rapidly developed in the winter of 1891-'92 a loud, rasping, 
basic systolic bruit, which was accompanied by a systolic apex 26 
THE BATHS OF NAUHEIM 
souffle. Her health rapidly failed, and the cardiac condition, 
involving as it did loss of sleep and appetite and steadily in- 
creasing dyspnoea, threatened to bring her life to a close. 
All ordinary resources having failed to afford relief, I sug- 
gested recourse to the Nauheim baths and treatment by exer- 
cises, with the practical details of which I was then unac- 
quainted. The journey, however, appeared to involve such 
serious risk that I did not venture to authorize it; but as Dr. 
Hermann Weber came to the conclusion that it probably 
afforded the only remaining chance of life, it was decided to 
undertake it. The distance from the English coast to Mainz- 
on-the-Rhine was covered by steamer. When again seen in 
the following October the patient was restored to her former 
measure of health and pursuing her usual avocations. 
In May, 1893, she returned to Nauheim for a second course, 
and on her return I wras unable to detect either the basic or 
apex bruit, and the heart was fully competent. 
A few words of general information for the traveler and 
invalid may be added. The hotels furnish good accommo- 
dation, and are most of them provided with lifts, a matter 
of much importance for heart patients. They are apt to 
be very full in the height of the season, and it is almost 
impossible to obtain rooms at the Kaiserhof in particular, 
which is now being altered and enlarged, without securing 
them weeks or even months beforehand. The villas, which 
are very numerous and usually stand in the midst of small 
grounds, are large, spacious, and well managed, the food 
and cooking being essentially German in character. Ar- 
rangements should be made beforehand as to whether 
board is to be provided or not, as many will prefer to take 
one at least of their meals at one of the hotels. Rolling 
chairs are to be hired by the week at reasonable prices, as 
well as attendants to push them. 
All ordinary articles likely to be needed can be obtained 
in the town ; others can be quickly sent from Frankfort. IN DISEASES OF THE HEART. 
27 
The summer climate of Nauheim, like that of the other 
Taunus resorts, is somewhat changeable, often cold and 
rainy, but seldom oppressively hot. The soil is good, and 
the position of the town favorable for health. 
The place is furnished with a water supply and a sys- 
tem of drainage said to be good, but the sanitary conditions 
are probably susceptible of some further improvement. 
Although the surrounding country is less attractive than at 
many other resorts, there are walks, drives, and excursions 
of much interest for those who are able to undertake them. 
The Kurhaus is large and handsome, and furnishes the 
usual means of recreation. Subscriptions have been already 
taken for an English church, and a piece of land secured 
upon which one will probably soon be built. The official 
season at Nauheim lasts from the 1st of May to the end of 
September, but the bath houses are open also in April and 
October. 
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