A. The General Circulatory Exercises may be divided into : -

(a) Exercises which stimulate the Heart to stronger Contraction, and consequently aid Circulation, especially in the arteries.

1. All active movements, with or without resistance.

2. Heart-hacking.

3. Nerve pressures.

(b) Exercises which promote the Venous Return.

1. All passive movements, especially rollings.

2. All exercises for inspiration (increase the negative pressure in the thorax).

3. Effleurage.

4. Kneadings.

5. Active movements also directly assist venous circulation.

B. Exercises which specially help the Pulmonary Circulation.

These consist of all respiratory movements which assist inspiration or expiration, or both.

C. Exercises which help the Portal Circulation.

1. Circle-turning.

2. Trunk-rolling.

3. Abdominal kneading.

4. Most Trunk exercises, because they produce alternate lengthening and shortening of the blood vessels in the abdomen, as well as alternation between increased and diminished pressure in the abdomen.

Exercises which specially influence the Distribution of Blood in the Body.

Among these there are three large groups : -

A. Exercises which deplete the head.

B. Exercises which deplete the abdominal and pelvic organs.

C. Exercises which replete the abdominal and pelvic organs.

In arranging the last two groups I have principally followed the opinions of Major Brandt.

A. Exercises which Deplete the Head.

1. All active movements which exercise large masses of muscles without impeding respiration. Such are specially : -

(a) Strong Leg exercises.

(b) Back exercises.

2. Neck massage.

3. Head-rolling and Neck-raising.

4. Head-hacking.

5. Inversion (momentary).

This is done by turning the patient upside down for a moment and then raising him again, so that the amount of blood in the head is diminished by the contraction of the blood vessels owing to reaction.

6. Pressure on the Jugular Vein (momentary) acts in the same way as the preceding. Formerly much used, but less so now. Great care is necessary.

B. Exercises which Deplete Abdominal and Pelvic Organs.

1. Stoop position, and, in general, movements given in this position.

2. Exercises performed chiefly by the Gluteal and Back muscles; Back-raisings, Leg-parting and -inpressing, etc.

3. All active Arm exercises which do not impede respiration. The strongest effect is gained if all the above actions are combined, e.g. : -

Yard-stoop-stride-sitting 2 Plane Arm-carrying. Stretch-stoop-stride-sitting 2 Arm-bending-stretching. Yard-stoop-stride-sitting Back-raising. Heave-stoop-stride-sitting Alternate Trunk-turning.

C. Exercises which Replete Abdominal and Pelvic Organs.

1. Arch position and, in general, all exercises in this position.

2. All active movements where Ilio-psoas works (see Movements for Flexors of the Hip joint, p. 196).

3. In general all strong Leg exercises, except those performed chiefly by the Glutei.

4. Leg-rolling.

5. Strong Sacral-beating.

6. Low or High Knee-arch-stride-standing Screw-twisting. This works very strongly.

Exercises which Soothe the Heart.

1. Stroking over the region of the heart.

2. Tapotement a l'air comprime in slow rhythm

3. Fine vibrations over the heart.

4. Back-hacking and Back-tremble-shaking.

5. All exercises which help venous circulation.

Exercises which Aid Digestion and Peristalsis.

A. All exercises which aid portal circulation (p. 292).

B. All active abdominal exercises. Partly by increasing pressure in the abdomen and thus stimulating the walls of the alimentary canal, partly by associated movement between the external abdominal muscles and the non-striated muscle fibres in the stomach and intestines.

C. All movements and manipulations which cause direct stimulation of the organs of digestion.

(1) Abdominal kneading.

(2) Stomach-pit-, Stomach-,Transverse-abdominal-, and Lumbarside-shaking.

(3) Transverse-abdominal-, Colon-, and Lumbar-side-stroking.

(4) Wing-stoop-stride-sitting Screw-twisting.

(5) Exercises with Abdominal and Lumbar pressure.

General Rules for making a Medical Gymnastic Table.

In the medical gymnastic treatment of a patient we do not usually limit ourselves to giving only what may be called special exercises, i.e., exercises and manipulations which aim at directly affecting the patient's complaint, but we extend the treatment as a rule to the whole organism, and give a so-called General Strengthening Gymnastic Treatment. This includes the whole body, and its objects are: -

1. To increase the supply of oxygen to the body in order to increase general metabolism.

2. To promote the activity of the organs of digestion, so as in this way to increase and facilitate the preparation and absorption of food substances, and thus make better use of the food.

3. To assist general circulation and consequently the distribution of food substances to the various parts of the body, so that nutrition everywhere is improved.

4. To produce general increase in the activity of the cells, either by direct mechanical stimulation of the organs and tissues by hacking, clapping, shaking, kneading, and other similar manipulations, or by reflex action, by suitable stimulation of the sensory nerves, e.g., by back-hacking, general nerve pressures, etc.

5. If the patient's strength allows, active movements for the large muscles of the extremities and trunk are also included in the treatment.

In arranging the treatment for a patient one chooses in this way a number of movements and manipulations, usually about eight to twelve in number, and comprising some with direct influence on the changes present, while the rest make up a general treatment on the above principles.

For the sake of regularity and supervision they are put together suitably as a table which the patient can go through daily, and preferably at the same time of day.