cises are an important means toward recovery. It is curious, however, that the invigorating effect of air or change of air is not due to its effect upon the lungs, and through them to the rest of the body, but to the effect upon the body and through it to the lungs. Many arguments have been advanced for and against pulmonary gymnastics and inasmuch as the same object is attained by walking on the level and uphill, it is wisest probably to avoid such exercises unless especially ordered by the physician. Muscular exercise increases the rate (number per minute) and depth of the respiratory movements. Now through the lungs the carbonic acid gas, a waste product of muscular activity, is gotten rid of and oxygen absorbed. During muscular activity more carbonic acid gas must be set free and more oxygen absorbed than when at rest. But not enough oxygen is absorbed to oxidize all the waste products of the muscles when exercise is taken, and these substances irritate or stimulate certain parts of the brain, and more frequent and deeper breaths are taken. This holds true no matter what set of muscles is exercised, provided only that they are of sufficient size. Walking, for example, on the level and up grades would suffice to exercise fully the respiratory muscles of a patient, who by this means of exercise takes three times as much air into his lungs as a patient who remains still. It may be of assistance to some to have these rules boiled down, compressed into small space, for ready reference. RULES FOR EXERCISE (Exercise means walking. Special permission must be obtained before indulging in other forms of exercise.) None if feverish None if blood in sputum None if loss of weight None if fast pulse Never get out of breath Never get tired Never lift heavy weights Go slow Exercise regularly and systematically whether rain or shine Walk uphill at start so as to come downhill on return Remember always that you will have to return Rest one-half hour before and after meals XII ON CULTIVATING AN OUTDOOR HOBBY AND ON RECREATION Better to hunt the fields for health unbought, than fee the doctor for a nauseous draught." THE mad rush of life in America means many different things to many people. To the Englishman, accustomed for years to a leisure class who devote themselves to sport, art, or travel, the man of affairs in America seems to have but one goal, riches. To them "trade" as a profession is incomprehensible and playing such a game inconceivable. The association of America with gold has been so pronounced since the discovery of Columbus to the present day, that to the majority of Europeans we seem to be engaged in a life-long struggle for the root of all evil or else in watering the plant. In other words, we spend our lives in preparing to live and never find time to live. There is, however, a growing tendency for a man to retire from business at an earlier age, but unfortunately for many, such retirement is often associated with a relaxation of mental as well as of bodily effort, which leads in some cases to a rapid deterioration of all the better qualities that made the man successful. He has developed no tastes, no pursuits apart from his business, which he must follow to escape boredom. This unfortunate state of affairs is true also when the business or professional man falls ill of tuberculosis. Apart from his calling he has little or no resources and, unable to follow his calling, he wanders about like a lost soul. The advantages of resources within himself have never before occurred to him and the therapeutic value of a hobby, an out-of-doors hobby, is an unknown thing. It is a curious thing, but play brings relapse more often than work. The writer frequently tells patients that how they will do depends more upon what they do after working hours. than upon their work. Put in another way it may be stated that they can play and get well, or work and get well, but they cannot play and work and get well. This means that recreation which entails exercise may add the proverbial straw. A patient who must return to work at the end of six months or a year must clearly realize that he must take much of his recreation while resting. In discussing recreations it may be well to generalize a little at first. A tuberculosis patient should cultivate outdoor pleasures whenever possible and, as soon as his condition permits him to move about, a wide field is open to him. On the porch, however, many take up bird study and with the aid of opera or field glasses it is remarkable how many birds a patient can come to know even while in bed. Botany, too, may be begun in a similar way, for many patients or friends willingly bring strange or common wild flowers to anyone whose field of action is strictly limited. It must be fully appreciated, however, that the bird life and plants of any locality are so great in number that at first the bewilderment of riches seems overwhelming. In a short time, however, the patient becomes orientated, and his pleasure and delight in the subject grow every day. Some, again, prefer geology, and glacial deposits and erosions have for them great interest. Photography is now made so easy that little experience is needed to take a fairly good photograph, but much study and interest can be aroused by pursuing such a hobby further, and for these color photography has perennial charms. After the patient has taken sufficient exercise, driving, gentle horseback riding, and automobiling may be indulged in, but—the amount must be prescribed by the physician. Croquet may be played, and later on under his physician's direction a little putting, followed later by a few holes of golf. The full swing in golf, however, cannot be recommended. Fishing from a boat entails little exercise when the patient does not row and prefers trolling. Later, rowing a light boat in calm weather or shooting, when it does not involve too much exercise is permissible. Hunt |