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As the treatment of anterior poliomyelitis at Warm Springs is in part dependent on the exercising of muscles in warm water, much thought has been given to the construction of pools and equipment for this special purpose. These notes on the results of experience here are presented in the hope that they may be of value to other interested institutions.

The present facilities consist of three large pools, one enclosed and two outdoor, all connected by waterways, so that patients may swim from one to another. Of the two outdoor pools, one, 35 feet by 69 feet, is equipped with tables for the various exercises. The other, the same size, is used for swimming and water sports. The enclosed pool which is heated and glass-roofed, was built particularly for winter use (35 feet by 85 feet), and is used both for exercises and swimming. In summer this pool is used for the treatment of those patients who burn easily from exposure to the sun. In all cases, the table exercising equipment is secured to the floor so that it may be easily removed to free an area for swimming or play.

Heating water for the pools has not been a problem at Warm Springs, since the water there comes from a natural spring, at a temperature of approximately 89o. It can, of course, be done artificially.

The outdoor pools for patients at Warm Springs have been adapted in part from old pools which existed before the organization of the Warm Springs Foundation; consequently their sizes are somewhat the result of chance. The 35-foot dimension, however, seems to be an economical width. It is sufficient for three rows of exercise tables. The 70-foot length allows for four tables. (See diagram A). Such pools could be increased or decreased in units of 12 feet in width from center to center of tables. The determination of this unit depends not only on providing sufficient working space for the operator but also on avoiding too much disturbance of the water. Choppy water hinders the operators as they are unable to see clearly under the surface. The indoor pool at Warm Springs was built 35 feet by 85 feet to provide a space for play in addition to an exercising area similar to the out-door pool.

The pools vary in depth from 4 feet to 5 feet. The indoor pool is 4 feet 6 inches at one end and 6 feet at the other, the bottom being sloped only for drainage. As diving is difficult or impossible for most patients a greater depth is not needed. The depth of approximately 4 feet 6 inches was arrived at as sufficient for swimming and not too deep for the average patient to stand on the bottom, as it is desirable for the patients to be able to walk in the water. Pools built specially for children should be relatively more shallow, though the young patients have used one end of the play pool at Warm Springs without hardship. Most patients contrive to get considerable exercise by holding to the pipe rail which encircles the pool at about the water level. This rail is also important as an aid to getting in or out of the pool. The water levels of the pools are maintained approximately six inches below the surrounding platforms, a distance less than the usual standard for pools. This was done as many patients find it easier to enter or leave the water by slipping themselves over the edge, consequently the less distance between the platform and the water the better. A scum trough is most desirable.

For entering and leaving the pool steps or ramps with rails must be provided. An arrangement which is adaptable to both adults and children and successfully used is shown in diagram B. Children use the lower rails and adults the upper. The steps were made wide to provide a place for patients and particularly children to rest from their exercise and yet remain in the water.

Numerous aids for giving patients under-water exercises are being developed by the medical staff at Warm Springs. The principal ones at the present time are as follows:

Wooden chairs, diagram C, secured to the floor with the seat at such a height that the patient's shoulders and neck are under water, are used for arm, shoulder and neck exercises. For children a small chair is secured on the seat of the larger.

Tables, diagram D. This table is extensively used for various groups of exercises. Its usefulness would be increased by making its height adjustable, as in all cases it is important to keep that portion of the patient under water which is being exercised. Cuts 1, 2, 3, 4 and 5 show how the table is particularly adapted to the different exercises. 1 shows the position of the patient on the table for abdominal hip flexion, lateral and anterior abdominals; 2 for abdominals, also abduction and adduction of the hip and rotation of the hip; 3 Patient on side for hip flexion, hip extension, knee flexion and knee extension, lateral trunk and the more difficult abduction and adduction exercises; 4 is lower back exercise, hip extension, abdominal exercises and abduction exercises; 5 is foot work, toes, ankles, knees, knee flexion and extension, hip flexion and hip rotation and back exercises.