or a window and a door leading into the open air. These, if at all possible, should be so placed that cross-corner ventilation may be had. It is very undesirable to have only one opening, which is usually a window, to the outside. If this must be the case for a time, see that the window is always open at the top and bottom. It has been previously stated that air like water flows straight away whenever possible. A bed in a corner is therefore in the worst possible place in regard to the amount of fresh air that passes over it. It should really be in the middle of the room, or at least in the middle of a wall, to get the freshest air. Draughts across the foot of the bed are of no moment, and some patients even sleep with a strong movement of air upon their faces without harm. The danger of draughts in a room is that the stream of air is usually small and plays upon a localized part of the body, while adjoining parts are subjected to much warmer air and less evaporation. This is the difference between draughts indoors and movements of air outdoors. Draught screens for the windows have been mentioned.

What has been said here relates to the house in winter, for, when all windows and doors are open, excellent ventilation can be had through the rest of the house.

The room should, of course, be as large as possible and removed from the rest of the house to isolate it, as far as possible, from the

necessary household noises and the odor of cooking. Only when very ill should the patient share his room with a nurse. It should, of course, be bright and well lighted at night.

The color of the walls should be a warm neutral tint and of such a texture that they can be easily cleaned. There is no objection to a few pictures and a few rugs on the floor. It must never be lost sight of that pulmonary tuberculosis is not an acute disease like typhoid fever or pneumonia, and what could be endured for a few weeks cannot be borne for many months. The room must be as cosy as is consistent with good hygiene. A fireplace adds much to the ventilation.

The room should of course be kept scrupulously clean, and only a damp cloth or dustless duster used for cleaning, or indeed a vacuum cleaner.

ΧΙ

ON EXERCISE

"Those who are accustomed to endure habitual labor, although they be weak or old, bear it better than strong and young persons who have not been so accustomed."

EXERCISE is as important as rest in the treatment of pulmonary tuberculosis but vastly more dangerous. We are all so accustomed to regulating our own exercise that it seems the height of folly to listen to anyone who allots to us only a few minutes a day for such a mild form of exercise as walking and then only upon the level. When exercise should be begun depends entirely upon the progress the walling-off process has made. When the dots of disease (called "tubercles") are so firmly and solidly walled off that exercise with its attendant increase of the circulation produces no evil effects, washes out no more poison than the body can take care of, then the time for leaving bed or beginning to walk has arrived. It is readily seen, however, that the onset of evil days may be so gradual, so stealthy, that even the trained observer may be puzzled to say whether or not they approach. If this be so, as it is, then it must be the height of folly for an untrained observer, whose mental powers and judgment have been weakened by

the disease-poisons, to attempt intelligently and cautiously to dole out his medicine, for in these cases exercise is medicine and dangerous medicine. It has been stated that few would care to dose themselves with arsenic or strychnine, when an unlimited quantity was placed before them, and they were told that one-fiftieth of a grain would benefit them, while one grain would produce serious symptoms of poisoning. They would no doubt hesitate long and decide finally in all probability that they would take their chances without depending upon the tonic effects of either drug.

Now exercise for the average patient with pulmonary tuberculosis works far more harm, poisons vastly more people, than either strychnine or arsenic ever does. But, like food and air and rest, exercise is at the beck and call of everyone, and most of us foolishly imagine we can employ it in our own case cautiously, skilfully, and helpfully. We argue thus from the fact that, while in health we have found that exercise benefits us, it should do so now. But we reckon without the tiny dots of disease and the poison they contain. There is no danger for the patient with pulmonary tuberculosis so great as that contained in exercise. His desire should

be to obtain the most expert medical advice he can and then faithfully and trustingly to follow it. The advice of the family, given in ignorance to do more than the physician says is fraught

with great danger. They only too often and too late recognize that the physician must have possessed some knowledge of which they were ignorant. So, too, with the advice of patients, who have taken the "cure" for years, who long since have given up hope of arresting their disease, and live long in chronic invalidism. They advise early and recent cases to take more exercise than their doctors prescribe, calling attention to the fact that they in their much worse condition can do so, and thus often work irretrievable harm to the beginner if he listens to their dangerous wheedling.

As soon as a patient leaves bed he begins to exercise. It has been found that simply getting out of bed and standing on one's feet raises the temperature, for many large and powerful muscles are called into play to keep the body erect. Even sitting in a chair requires more food to prevent loss of body substance than lying in bed. Walking increases the amount of food needed very considerably. If a man weighing 132 pounds walks two and one-half miles an hour, he requires 132 calories of food over and above what he needs while resting. Such facts must be borne in mind constantly. The question of when to get up must be decided by the physician, but how to get up may be discussed in detail here. The effects of overexercise are not immediately apparent. The rise of temperature produced by the poisons flushed from the diseased areas into