that the person taking part in it does not have a defective heart. This jumping and springing exercise is not good for such defective individuals; otherwise the exercise is splendid. Rowing is good exercise if it is done deliberately and not against time or against a competitor. When the rowing is competitive, especially if the individual has not been sufficiently trained, or if the distance is too great, heart strain is easily caused, and even permanent cardiac disability. Horseback riding is again becoming the vogue. It is splendid exercise for the whole body, especially if the horse trots; if the horse is spirited the exercise becomes strenuous.

The development, in many of our cities, of the class method of instruction in the various arm, leg, and body exercises; the gymnasiums and swimming pools in the Young Men's Christian Association buildings; and the tramping, marching, and other exercises for the Boy and Girl Scouts are all of great benefit to young people.

The Delsarte system of physical culture is taught more or less privately, sometimes in classes, often by women teachers, and is a special form of exercise aimed to teach good carriage and, especially, how to properly walk and properly stand. This teaching has been more or less superseded by the dancing craze, and now, not quite so much as two or three years ago, old people as well as young are taught to dance. Dancing is splendid exercise, and teaches graceful movement and graceful carriage. However, young people carry this craze more or less to excess, and some of these dances are absolutely inexcusable from every decent and moral standpoint. Public dancing between the courses of a meal, or in the midst of the different courses, is against good sense; also it is unphysiologic to dance immediately after a meal. Too much dancing is not good for anyone, and excessive dancing by young girls and by older people and by anyone with a cardiac defect is absolutely unjustifiable.

Exercise For Adults.-Besides walking, horseback riding, and tennis, golf represents one of the best exercises for adults. The walking on the golf course may be done slowly or rapidly as one desires, and at golf the mind is taken off from business, and the nervous tension is not great. The only tendency of the

golfer is to strive to play too long in one day or at one time, and he seems to be as proud of telling how many holes he has played as is the novice in automobile driving to tell how many miles he has covered in a certain time. When the number of holes played is the object of the game, the exercise can do harm, especially to the middle aged; but if the individual, business or professional man, lives a strenuous, nervous life, there is nothing better than golf as a sport, as an exercise, as a relief from mental strain, and to generalize the circulation of the blood. If, however, the individual is physically weak and has circulatory defects, even golf, as well as walking, may be a disadvantage to him and actually cause harm. Such an individual should first seek advice as to the proper diet and proper amount of exercise he should take, and frequently a rest cure is what he really needs rather than exercise.

Fishing can be made strenuous or as restful as the laziest man could desire; but it presents perhaps the greatest amount of mental rest of any sport that can be offered. Hunting is always more or less strenuous, unless a man has the time to camp out and get the whole benefit of the outdoor life of such a trip.

So-called "Athletics." The immediate results and the future results of competitive athletics is a subject now of wide discussion. Even after ordinary competitive exercise, or with too rapid training, the individual may become dizzy and fall, or he may have palpitation of the heart that may last some time. He may be so prostrated that he vomits, and frequently albumin and casts appear in the urine after strenuous exercise. Acute dilatation of the heart, and rarely death, can occur after severe athletic labor. A heart may become dilated to such an extent that the individual is prostrated for weeks and perhaps months, and he may never again recover his former cardiac strength. Any young man who develops, with the amount of exercise that his companions can sustain, any of the above symptoms should generally be prohibited competitive athletics.

Before any boy or young man begins training for competitive athletics he should be very carefully examined physically, and all defects noted, and if he has a disability, all exercise that is strenuous should be prohibited.

A very important question at the present time is: what is the future of individuals who are physically fit, and who stand their strenuous athletic work during the athletic age and during the period of their severe competition without apparent injury? Statistics of insurance companies show that athletes as a class have a shorter lease of life than individuals who have not been subjected to such strenuous work. They develop cardiovascular and renal disease at a younger age than other men of the same class. They are also frequently found to have a systolic blood-pressure much higher than normal for their age. They all have more or less hypertrophied hearts, which keep the blood-pressure high after the strenuosity has ceased, and many an athlete immediately feels the loss of exercise when he ceases his hard training and begins his life work. Also the hearts of athletes, which have been worked to the limit, do not as well respond to such emergencies as severe injuries, operations, pneumonia, or other serious disease, and such patients die of heart failure when theoretically they should survive.

The drawn, anxious expression, and the fixed contraction of the facial muscles of an athlete, while he is at his hardest strain or at the end of the period of strenuosity, may be noticed and recognized by any observer. This is really the heart strain, and the phrase "the heart-breaking" or "the heart-rending finish" is a truthful one.

These are facts and not theories. Therefore physicians should use their influence to prevent growing boys and girls from taking part in competitive athletics that require enormous strain. This does not apply to baseball, and may not apply to short runs; it certainly does apply to football in growing boys, and applies to basketball in growing girls, and may apply to almost any exercise, if participated in too long or too strenuously.

Competitive athletics in our universities undoubtedly does an enormous amount of harm to the very best of our coming citizens. It is only the most physically fit that are selected for competitive athletics, and they are urged by every method known to the athletic clubs of the university, and by the ordinary human spirit of the desire to win, and by the depend

ence of the university upon them to win, to exert themselves to their utmost limit, to their future, if not their immediate, undoing. If these selected individuals become ill during their training, they are rarely allowed a sufficient convalescence, but as soon as they are partially physically able, are rushed again to their strenuous labor. If such individuals use a large amount of tobacco, they have one more handicap in this cardiac strain that they must undergo.

Besides the actual strain on the heart and arteries, the aortic valve may become diseased by actual physical injury through the increased aortic pressure, and narrowing of this valve is not infrequent early in life in these athletes.

The serious injuries that may occur from football in the way of fractures, ankle sprains, shoulder dislocations, and injuries to knees, some of them perhaps permanent, to say nothing of the damaged eyes, torn ears, broken noses, or perhaps some abdominal injury, are so frequent that but little notice is taken of them. Occasionally concussion of the brain, or hemorrhage into the brain, or broken necks and broken backs are the outcome of this game that, even with the present modification of the rules, is altogether too strenuous for tolerance by a thinking people.

In endeavoring to prevent heart strain in young college athletes, it should be considered that a mile is long enough for the freshman boat race, and that two miles, or at the most, three, is long enough for the "varsity" boat race.

Exercises for Diseased Conditions. The proper training, or retraining, of muscles whose function is impaired, whether due to cerebral paralysis, to poliomyelitis, to locomotor ataxia, or to any other serious nerve and muscle disease, is an important study, and the good results obtained by such training is recognized by all specialists in nervous diseases and by all orthopedists.

Graded exercises should be a part of the treatment of circulatory weakness, whether due to heart disease, to obesity, or to some other cause. These graded exercises have been termed the Schott system and the Oertel system of treatment. A part of the well established notoriety of the Nauheim treatment of

heart disease is due to the graded exercises there outlined by Professor Schott. These treatments are combined more or less with baths, with a rigid, carefully selected diet, and with forced rest periods. In heart defects the exercise begins with walking, and is gradually graded until hill-climbing and gymnastic work is done. All exercise is carefully supervised by the physician in charge, and if dyspnea is caused, or any other bad symptoms occur, the exercise is curtailed until such work can be done without undesirable symptoms.

The exercise used to diminish obesity is more strenuous, and to be successful it must be combined with a modified diet and, generally, with baths.

There are a great many so-called sanatoria for the more strenuous fads to reduce weight and to improve heart strength. Some accomplish a great deal of good; others exist for commercial reasons only. However, it should be recognized that strenuous exercises, whether advised by book or by correspondence, should not be undertaken unless a physician sanctions it after a careful physical examination. Serious harm can be done by exercise of any and all kinds.

While deep breathing exercises are of great value in developing the chest, much harm can be done by deep breathing and forced expansion in pulmonary tuberculosis. Too much exercise of a lung can open up healing, contracting areas in the lungs, increase absorption of toxins from the tubercles, may cause hemorrhage, and often promotes coughing. Such breathing exercises are of value, if graded, only after the lung lesions are completely healed, to regain the best possible lung capacity. Sometimes gentle prolonged inspiration (but not too deep or to the point of forced expansion) for a short time is beneficial by controllng the tendency to cough. Frequently it is the prolonged expiration that increases the irritable non-productive (without expectoration) cough.

REST CURE

This is often termed the Weir Mitchell treatment. Dr. S. Weir Mitchell, who died not long ago well along in honored years, was one of the most able clinicians that America has pro