HEALTH 
GYMNASTICS 
BADEN-BADEN. 
BY 
WILLIAM HUNT, M.D., 
Senior Surgeon of the Pennsylvania Hospital, Philadelphia, and one 
of the Surgeons to the Orthopaedic Hospital, also Associate 
Editor of the "Annual of the Universal 
Medical Sciences." 
Reprint from 
" The Satellite of the Annual op the Universal 
Medical Sciences," November, 1888. 
PHILADELPHIA: 
MEDICAL BULLETIN PRINTING HOUSE. 
1888. Health Gymnastics 
Baden-Baden. 
BY 
William Hunt, M.D., 
Senior Surgeon of the Pennsylvania Hospital, Philadelphia, and one of the Surgeons 
to the Orthopedic Hospital, also Associate Editor of the "Annual 
of the Universal Medical Sciences," 
REPRINT FROM THE 
"Satellite of the Annual of the Universal Medical Sciences," Nov., 1888 
PHILADELPHIA: 
THE MEDICAL BULLETIN PRINTING HOUSE. 
1888. Health Gymnastics at Baden-Baden. 
BY 
WILLIAM HUNT, M.D., 
Senior Surgeon of the Pennsylvania Hospital, Philadelphia, and one of the Surgeons to the 
Orthopsedic Hospital, also Associate Editor of the "Annual of the 
. Universal Medical Sciences." 
So great a place is now given to systematic gymnastics in ortho- 
paedic treatment, and also in other forms of muscular and nervous 
derangements, that a notice of one of the principal establishments for 
their application will be appropriate. 
The institution alluded to is the one at Baden-Baden. The writer 
has recently had personal experience of its benefits. He was the sub- 
ject of a severe accident in the early spring of 1887. Among other 
injuries, he had comminuted fractures of the right clavicle and the head 
of the humerus, and great contusions, if not deeper injuries, of the 
muscles of the neck. After partial recovery he went to Europe, and 
was obliged to halt on account of sickness and debility at Baden- 
Baden, and while there took advantage of the baths and gymnastics, 
though but for a short time, yet with great benefit. 
The second floor of the great and beautiful hall of the Frederichs- 
baths (three hundred feet long, and, say, from thirty to forty wide) con 
tains more than fifty machines adapted to the special exercise and to the 
massage of every part of the body. The details below are translated 
from a pamphlet by Dr. Heiligenthal, the director of the institute.* 
The machines are mostly, if not all, those of Dr. Zander, of 
Stockholm, and were made there. Their cost, independent of the 
appliances to set them up and to run them, ranged from five hundred 
to fifteen hundred marks apiece. Most of them are entirely noiseless 
in their movements, and even those operated by steam make very 
little and no unpleasant sounds. They are superintended by well- 
trained assistants, who strictly carry out the written prescriptions 
given in each case. 
* Die Apparate fiir Mechanische Heilgymnastik und deren Anwendung im Gross- 
herzogl' Frederichsbade in Baden-Baden. Von Dr. F. Heiligenthal Grossherzogl' Hof- 
rath und dirigender Badearzt am Frederichsbade und den Grossh. Kuranstalten. 4 
Health Gymnastics at Baden-Baden. 
The apparatuses are divided first into two series: First series, 
those moved by the patient (Bewegungsnehmer); second series, those 
moved by a motor, as by a steam or gas machine. 
According to the conditions of their physiological operations 
there are three divisions :- 
1st. Apparatus for active movements, z.e., those which have the 
immediate property of exercising and developing the muscles. Of 
this division there are three groups:- 
A. Active arm movements. 
B. Active leg movements. 
C. Trunk movements. 
D. Balance movements. 
2d. Apparatus for passive movements, z.e., those which, without 
the help of the muscles, move the members of the body, and so stretch 
and soften the capsules, ligaments, and muscles. 
This division contains one group :- 
E. Passive movements. 
3d. A pparatus exercising mechanical influence. 
This division has four groups :- 
F. Concussion movements (Erschiitterung). 
G. Hack, or tapping movements (Hackung). 
H. Kneading movements (Knetbewegungen). 
J. Stroking and rolling movements of muscles (Streichung and 
Walkung). 
These last groups all comprise forms of steam or mechanical 
massage. The English equivalents of some of the names are hard to 
express. 
In reference to series, it will be seen that the first series includes 
groups A, B, and C, and the second groups 2), E, F, G, H, and I. 
The first series of instruments are the most numerous. 
I. 
The machines for- 
A 1. Arm depression. 
A 2. Arm and shoulder elevation. 
A 3. Arm depression and flexion. 
A 4. Arm raising and extension. 
A 5. Drawing the arms together (adduc- 
tion). 
A 6. Carrying arms sideways (abduction). 
A. Active Arm Movements. 
A 7. Rotation of shoulder-joint. 
A 8 a. Rotation of arm (pronation and 
supination). 
A 8 b. Rotation and change of movement. 
A 9. Forearm flexion. 
A 10. Forearm extension. 
A 11. Flexion and extension of hand. 
B 1. Hip flexion. 
B 2. Hip extension. 
B 3. Hip-knee flexion, or raising of hip. 
B 4. Hip-knee extension. 
B 5. Closing the legs (adduction). 
B 6. Spreading the legs (abduction). 
B. Active Leg Movements. 
B 7. Velocipede exercise. 
B 8. Rotation of legs. 
B 9. Knee flexion. 
B 10. Knee extension. 
B 11. Foot flexion and extension. 
B 12. Foot rotation. Health Gijmnastics at Baden-Baden. 
5 
Cl. Flexion of trunk forward (sitting). 
C 2. Straightening of trunk (while sit- 
ting). 
C3. Flexion of trunk (lying). 
C 4. Raising of trunk (sitting). 
C. Active Trunk or Body Movements. 
C 5. Straightening of trunk (standing). 
C 6. Bending sideways. 
C 7. Rotation of trunk. 
C 8. Rotating pelvis. 
C 10. Neck stretching. 
D 1. Trunk balance. 
I) 2. Trunk concussion in side-sitting. 
D. Balance Movements. 
D 3. Trunk concussion in straddle or rid- 
ing position. 
II. 
E 2. Passive hand flexion and extension. 
E 3. Passive radial and ulnar flexion of 
the hand. 
E 6. Breast or chest expanding. 
E. Passive Movements. 
E 7. Passive trunk rotation. Pelvis side 
swinging. 
E 8. Pelvis raising. 
III. 
Mechanical Influence. (Forms of Massage.) 
F. Concussion movements. 
F1. Concussion or shaking movements. 
G 1. Tapping. 
G 3. Leg tapping. 
G. Hack, or Tapping Movements. 
G 4. Trunk tapping. 
G 5. Head tapping. 
Hl. Abdominal kneading. 
H. Kneading Movements. 
J1. Arm stroking and rolling. 
J 3. Leg stroking and rolling. 
J 4. Foot rubbing. 
J. Stroking and Rolling Movements. 
J 5. Back stroking. 
J 6. Rolling the abdomen. 
All of these instruments are described in full, the particular 
parts and the especial muscles and groups of muscles which they 
exercise, either actively or passively, are named, and the diseases 
or conditions to which each is applicable are mentioned. We cannot 
give space for all, but will describe and copy the illustrations of a few 
of them, and state their uses briefly. The copies are admirably well 
done. One can readily see the uses of the different parts, and dis- 
tinguish those moved by the patient from those moved independently 
of him. 
We will first give an abstract of general remarks, taken from 
Dr. Zander:- 
" All movements should be taken lightly at first. The taker, 
although he may think them too weak, should not himself increase 
them on the first days of trial, for it is not only the one weak and 
apparently trifling movement that he has to consider, but the combi- 
nation of them, which work together both upon the muscles and 
nerves, and he will often feel, particularly toward evening, much 
more tired than he would have thought. 6 
Health Gymnastics at Baden-Baden. 
u Remember that the gymnastics make a much deeper impression 
than the ordinary and mostly automatic movements of daily life. 
" The balance-weight of the apparatus, the scale of which has been 
prescribed by the doctor, and which he has deemed sufficient, must 
not be altered by the instructor, excepting when it proves to be too 
heavy; on the contrary, it should not at once be raised should it seem 
too light. It may not be wise for weak persons to take all movements 
prescribed on the first days. 
■A 3.-Arm Depression and Flexion. (An illustration of "Active Arm Movements.") 
The balance-weights having been adjusted according to the prescription, the head is held straight and the 
breast pressed forward. A deep inspiration is taken ; then during expiration the arm is drawn downward until 
the hands are brought to a level with the shoulder, the elbows being carried close to the body and directed 
backward. This exercise develops the chest, also the muscles of the whole upper extremity, the ones most 
benefited being named in the text. 
u A few minutes' rest is absolutely necessary for weak persons 
between each exercise. Stronger persons may take a group of them 
of the same order before resting. In this way the powers grow slowly 
but surely. Light exhaustion, or tiredness, need not be too carefully 
avoided. Labor to a certain degree of exhaustion is a necessary 
accompaniment of the growth of the powers. The great rule for 
patients is to use the movements up to the point of a light but rapidly 
passing fatigue. 
" Sometimes there are patients who seem not to be able to over- Health Gymnastics at Haden-Baden. 
7 
come fatigue, even by very slight exercise. They must not lose 
courage, for this phase may last for weeks, and even months, but it 
will pass off, to be followed often by a rapid improvement. It is not 
to be allowed, for it is absolutely wrong for patients to alter exercises 
different from those that have been prescribed. The physician only is 
to do this. The patient, left to himself, will leave off those which are 
unpleasant, and which he does not see the use of, and take others 
which are more agreeable, if acting through his own will. It is natural 
that those movements which are pleasant and easily performed should 
A 5.-Drawing the Arms together (Addiction). (Another illustration in the 
active list.) 
This apparatus for the horizontal flexion of the shoulder-joint acts particularly in the development of the 
muscles of the breast and the anterior and lateral aspects of the shoulder. The seat for the patient is so 
raised or depressed as to allow the arms to rest comfortably upon the levers, and other adjustments are made. 
A full inspiration is taken, and during expiration the arms are drawn toward each other until the levers 
touch at the ends, then during an inspiration the arms are carried slowly backward to the starting point, 
and the movements are repeated until the time is up.' 
be preferred, but they may be made at the cost of not developing 
muscles when the use of them is fatiguing and unpleasant. 
" The proper management of the breathing is an absolute necessity 
in gymnastics. Certain muscles, particularly those connected with 
the arms, chest, back, and abdomen, work in such a way that definite 
rules as to the relations they bear to respiration may be laid down. 
These have been carefully studied. Every active movement has a 
greater and a less stringent or tension moment. The first corresponds 8 
Health. Gymnastics at Baden-Baden. 
to that part of the movement when the resistance is overcome, as in 
weight raising, and is coincident with the shortening of the muscles; 
the last is when the resistance subsides, and the resting point is 
reached through a gradual lengthening or relaxation of muscle. Now, 
as the act of breathing also has a greater and a less, tension point, 
there follows this general rule:- 
" The point of greatest tension in movement agrees with expira- 
tion, that of less tension with inspiration. There are a few excep- 
A 7.-Rotation of Shoulder-Joint. Arm Rolling (Armschlendern). 
("Active Arm Movements.") 
The patient sits high enough for the axillary fork of the apparatus to fit comfortably. The arm is 
stretched along the horizontal lever, which is grasped by the hand. With an almost insignificant application 
of strength, the apparatus is set in motion first in one direction and then in the other. This movement can be 
made with slowness and with great rapidity. The balance-weight must be kept screwed to its place. The 
exercise should last from one to two minutes. [This machine was of great service to the writer.] 
tions, which are named, in which the chest during muscular contrac- 
tions takes inspirations, as in the use of A 2, A 4, A 6, C 2, C 4, 
C 5, C 10. With these the high-tension movement corresponds with 
inspiration." 
I can confirm the above interesting remarks as to breathing 
during the exercises. One would think that nature controlled this 
matter, and that one would automatically accommodate his breathing 
to the situation. But he does no such thing. The new man is Health Gymnastics at Baden-Baden. 
9 
absolutely fresh or "green" about it. The chief (often the only), 
sounds one hears ovei' the room are the different instructors in a 
low voice saying to their charges: "J?wathmen" (inspire), "Aus- 
This apparatus acts upon the muscular system of the hip-joint, particularly upon those muscles which 
move the extremities sideways. The patient, in the sitting position, places the calves in the stirrups or rests. 
After a full inspiration he carries the legs outward while expiring; then during inspiration he slowly draws 
the limbs inward to the place of beginning. This is very useful in weakness and stiffness of the hip-joint. The 
muscles most worked are the posterior third of the gluteus medius and minimus; the pyriformis, obturator 
internus, and the gemelli. 
B 6.-Leg Spreading (Abduction). ("Active Leg Movements.") 
B 12.-Foot Rotation (Fuss Rollvng or Fuss Kreisfn). (Another illustration 
of the ''Active Leg Movements.") 
The patient sits so far from the apparatus as to have his leg extended during practice. The foot is so 
moved as to describe an arc with the toes or points, the centre being the heel. The foot is fastened upon the 
movable plate, and so rests in a stirrup that the ankles are in a line with the screw of the iron frame. A 
balance-wheel is set in motion with the hand, which motion is kept up by efforts at flexion and extension and 
rotation of the ankle-joint. For weakness and stiffness of the ankle-joint this exercise is of great use. 
athmen " (expire), and it takes much practice to learn how to breathe 
properly. This I regard also as a great health-giving adjunct to the 9 
Health Gymnastics at Baden-Baden. 
C 4.-Raising or Trunk (Sitting) (Sitzenbe Rumpf-Streckung). (An illus- 
tration of the "Active Trunk Movements.") 
The patient sits first bent forward, with legs extended, and the feet firm against a movable foot-board, 
and then stretches and inclines the body backward. The catches are raised on the left, and on the right by a 
wheel the foot-board is fixed. The straps are put in position, and the hands so placed to the sides that they 
hold them firmly to the back by means of the thumbs : then, during inspiration the body can be bent back- 
ward, and forward during expiration. This exercise is useful for the back, neck, popliteal space, etc. 
El.-Pelvis Side Swinging (Becken Settenschwtngung). Passive Trunk- 
Rotation. (An example of " Passive Movements.") 
This apparatus moves by steam or gas power, which gives a side-swinging movement to the seat. The 
amount of motion to the right or left is regulated by scale. The patient sits with the feet on the iron step, 
the thighs are held down by bands, and the shoulders are placed over the cross-bar. Swinging, side, and 
rotation movements are produced from right to left and from left to right. The muscles of the baek are 
exercised, the ligaments stretched, and the viscera both of the thorax and abdomen are favorably affected. 
Sluggish circulation is benefited, and lumbago and constipation often relieved. The exercise should last 
from one to two minutes. Mechanical Massage at Baden-Baden. 
10 
exercises. All the movements are to be made quietly and moderately. 
The following general directions are to be observed :- 
" To act without hurry, and to take suflicient rest between the 
prescribed movements. 
" Not to tire one's self before or after the exercises-a direction 
particularly for all weak persons, and those inclined to or having heart 
affections. 
" Immediately to inform the doctor if a great or lasting fatigue 
follows the exercises. 
" The movements must absorb the attention of the patient, and he 
must not indulge in conversation while taking them. ' 
"Dancing and night vigils must be avoided while taking the 
gymnastics for general weakness, or for sickness. 
" The clothing should be loose and light, the waist, neck, and 
arms free; collars, corsets, and garters should be taken off. 
" A light meal, if any, may be allowed before the exercises. It 
may be necessary for weak persons to have a cup of tea or coffee. 
Milk-biscuit and bread and butter in moderation are harmless, but 
after a full breakfast an hour or two should pass before beginning 
the exercises." 
The Baden-Baden institute has one grand advantage over most 
others. This is the magnificent system of baths, which are in the 
same building. Hot, cold, tepid, mineral, wild or gravel baths, 
showers, and douches of all sorts may be had. 
Public or private baths may be used, all under trained assistants. 
The charges for advice, for the gymnastics, and for the baths are very 
moderate. 
Probably nothing more useful in its place, and nothing more 
abused, has been introduced into practice within the last twenty years 
than massage. Rubbings and frictions have been practiced for reme- 
dial effects from time immemorial, but the systematic, scientific intro- 
duction of massage is a thing of late years, and owes its extensive use, 
in this country at least, to Dr. S. Weir Mitchell more than to any 
one else. In spite of the lessons, however, which Dr. Mitchell has 
laboriously taught as to its use, there is great ignorance on the part of 
most masseurs about it. This is not to be wondered at, since most of 
them have no anatomical or physiological knowledge, and very little 
comprehension of the power which they are wielding. The effects of 
massage on the different tissues, the circulation, and the organs, as 
demonstrated by von Mobengeil at Bonn, and others learned in the 
matter, are truly wonderful. It is, therefore, a great agent for good 
or for evil. 12 
Mechanical Massage at Baden-Baden. 
[The next four plates are examples of what are called mechanical influences, and 
are really illustrative of forms of machine or steam massage. The instruments all 
move by power.] 
This machine when set in motion gives a peculiar concussion or shaking movement, which varies in 
rapidity and force according to what is required. The drawing represents the patient applying the cross-bars 
to her legs. The same portion of the machine may be used as a seat, in order that the trunk viscera and 
pelvis may be shaken up. The pad upon the upright may be regulated to varying heights, so as to be applied 
to the neck, shoulders, back, chest, and abdomen, and pails of different shapes, according to the part to be in- 
fluenced, are used. The applications of this apparatus are very numerous, a full list of which is given in 
the pamphlet. 
.Fl, Concussion Movements of Various Parts of the Body. 
G. Tapping Movements. 
The three little hammers to the left, in the above plate, tap alternately and with greater or less rapidity 
the part to which they are applied. The height may be regulated, and the patient can stand or sit. The influ- 
ence on the tissues at the point of contact is very marked, and the neighboring parts also partake of it through 
transmission and the effect on the circulation. Mechanical Massage at Baden-Baden. 
13 
Now the writer, speaking from experience in his own case, and from 
his knowledge about some others, abhors personal or manual massage. 
He has had those considered skilled operating on him, and, apart from 
the unpleasant contact and mauling, one and all had no comprehension 
as to time and exhaustion. " If you could only give me a full hour," 
was their talk, and then they would begin at the toes, determined to 
make a complete thing of it. He, therefore, took massage as he would 
take a dose of bad medicine, and was by no means comforted. He has 
known delicate women sickened by the same perverseness on the part 
JI. Arm Stroking and Rodding (Streickung and Wadkung). 
It is rather difficult to express the exact meaning of these words as applied to the movements. The cut 
represents the arm passed through a peculiarly made elliptical band, the hand grasping a holder which allows 
the arm to move through the band forward and backward from wrist to shoulder. The pressure is regulated 
to a nicety. Its structure, also, has much to do with the peculiar etlect. This, to my sensations, is that of 
absolutely perfect and regular massage, a combination of pinching, rolling, and rubbing of the muscles which 
is very agreeable when the pressure is properly adjusted. 
of the masseur as to time. The mercenary equation really seems to 
play an important part in the matter. The hour is considered as be- 
longing to the patient, and he or she is entitled to their money's 
worth. Considerations of this kind may also influence the patient, as 
■well as the masseur, but they are all wrong. The misunderstanding, 
or real want of knowledge, about massage must be very general. Dr. 
David Grant says, in a recent lecture : " In England, in most cases, 
the so-called massage is protracted to an inordinate length, the poor 
patient being pinched and pummeled for an hour, or even more, twice 14 
Mechanical Massage at Baden-Baden. 
a day." He thinks a sitting should not be prolonged more than ten or 
fifteen minutes, and that a good masseur can accomplish all physio- 
logical and therapeutic needs in that time. Whatever is added simply 
fatigues. Two sittings daily are mistakes under nearly all circum- 
stances. 
The above cut is an example of a massage machine for the lower extremities (Beinwalkung). 
Now, all these objections to massage were (speaking personally) 
obviated at Baden-Baden. While there also manual massage is used 
in appropriate cases, the beautiful instruments of Zander, of Stock- 
holm, for applying it mechanically, running by steam and regulated 
to a nicety, were vastly more effective and comforting to the writer 
than the other method. They may be regulated so as to give the 
gentlest or the severest rubbings, frictions, kneadings, tappings, 
rollings, etc. (Reibung, Frottirung, Knetbewegungen, Hackung, 
Walkung, etc.). The numbers using them with benefit amply testified 
to their value. The time for each application varies from one to five 
minutes. In ©ne room there is a sign of caution to the attendants 
and of admonition to the patients, that no machine there is to be 
used at one time for more than three minutes, unless otherwise 
ordered by the doctor. 
In contrasting the two methods, the writer was convinced, in his 
own case at least, that " there is nothing like leather," for this material, 
together with rubber, steel, and caoutchouc, is largely used in the Recent Therapeutics of Infancy and Childhood. 
15 
make-up of the various pads, rubbers, and belts with which the patient 
conies in contact. There is no exposure of the bare skin during the 
applications. Separate hours are allotted to the sexes. 
The writer is perfectly aware that mechanical massage has been 
and is used in this country, but what he has seen of it is crude com- 
pared to what is to be had abroad. Dr. George H. Taylor, of New 
York, has published a small volume in which he treats of it to a cer- 
tain extent. Even the splendid set of machines, both for gymnastics 
and massage, at Baden-Baden, are not yet quite complete. When 
the bathing accompaniments are considered, the place, so far, is 
unexcelled.