In corroboration of the reasons stated, I will add that soon after I had treated the case just detailed, I saw in the public press that the surgeon, whose wife had been my patient, had applied the old method of treatment for a sprained ankle for one of his wealthy clients.

From what has been written I think it is plain why rational and hygienic modes of treating diseases advance so slowly in this country, where, otherwise, every new idea, if in any way rational, is eagerly taken up and pushed forward to full development. 1023 Sixth Avenue.

GYMNASTICS A HEALTH MEDIUM.

BY ROBERT NOHR, M.D.

PHYSICAL education through regular practice in the control of the muscles is finding more and more general recognition. Physical exercise, in short, gymnastics, may be considered from different points of view. The object to be attained is not always the same, and exercises are arranged with reference to their special physiological effects. The execution of desirable movements enables one to improve certain conditions and to counteract the deforming and degenerating influence of habitual positions; but it must be borne in mind that the results of intelligent direction can only be attained by oft repeated and long continued effort. Normal conditions are the result of regular, not spasmodic, actions.

EXERCISE IN PLACE OF MEDICINE.

It is customary, where deviation from normal muscular strength is apparent, to take drugs. The other method would be to discard medicines at times and take natural exercise. If a physician who has been a gymnast, or one who has had some experience in gymnasium work, can prescribe

such, a physician is the one to address. Oth¬ erwise a competent physical director might be consulted.

A careful selection of movements and exercises, suitable to the individual needs, naturally involves a knowledge of the muscular organism and its action with reference to its influence upon the vital organs.

The value of the exercise is judged by the perceptible results in the individual, as improvement in proper functioning and general condition as well as in carriage, bearing, growth, and development; also by the increased activities and capacities for work, co-ordination, presence of mind, and improved disposition. Regular exercise increases the power of assimilation, builds new tissues and helps the system readily to eliminate waste materials.

In a working muscle the vessels are widened, the blood has freer course, the intramuscular respiration becomes more active, and the interchange of material becomes quicker. The consumption of oxygen and the formation of carbonic acid are also augmented. Simultaneously, muscular irritability is diminished, and the muscle gradually becomes fatigued, in spite of the enhanced supply of blood, which cannot long compensate the opposing factors. This is principally due to the accumulation of the so-called fatigue products (carbonic acid, lactic acid, etc.). Through the consumption of oxygen and through the lack of material which may be still further oxidized, heatproduction is increased and the temperature of the blood within the muscle and in the circulation outside of it rises. The nutrition of the muscle itself is favorably affected by exercise; just as a prolonged period of inactivity produces an atrophy, exercise will restore muscle to its normal value or even cause functional hypertrophy.

Gymnastics is of importance, however, in still other directions. Just as we have good reason for assuming a nourishing influence upon the muscles from their corresponding nerve centers, so may we assume that there is a reciprocal influence exerted upon the same nerve centers by the muscles and that

the nutrition of the former depends largely upon that of the latter.

INFLUENCE UPON CIRCULATION.

Since a working muscle takes up more blood than a resting muscle, and since the muscles represent a very considerable part (45 per cent.) of the total volume of the body, the power of gymnastics to compensate certain anomalies of the circulation and to deflect the blood from congested internal organs into the muscles, is very evident.

Further, the influence upon the heart, whereby it increases the pulse rate and force, thus strengthening the heart muscle itself, belongs here.

Finally, it is generally known that gymnastics quickens respiration, increases the radiation of heat and secretion of sweat as well as other secretions, causes more vigorous movements of the intestines, improves sleep, helps the appetite and exerts a favorable influence upon the general bodily condition.

In simple free movements the muscular activity is concentrated upon certain parts or limbs of the body. The more complicated the movements, the more is the muscular activity distributed over the body.

Passive movements, or those movements executed by force of another person, machine, or by gravity, are classed with gymnastics chiefly on the ground that they afford exercise to the joints and are very important in the treatment of diseased conditions of the same. By means of passive movements adhesive or other organized products of inflammations are stretched or torn apart, shrunken articular capsules and ligaments are stretched and portions of synovial membrane which have grown together from long continued contact are separated again, causing a quicker restoration of lost functional power to be brought about than otherwise possible, and to prevent the changes which result from a too protracted rest, such as excessive shrinking of the soft parts, vascularization, connective tissue metamorphosis,

and in some cases, finally, the growing together and ossification of cartilages.

Further, passive movements promote the free play of tendons and muscles in sheaths; prevent or remove the growing together of the same. Nevertheless, the power of these movements to stretch tissues is tolerably limited; more powerful means for this purpose are to be had in various orthopaedic procedures. Kneading and rubbing (massage) are to be classed as passive movements.

Orthopedics are properly the treatment of bodily deformities. Since this form of treatment is for the most part carried into effect by means of mechanical devices and apparatus of various sorts, the word orthopædics has come to denote the mechanical treatment of such conditions.

TOO LAZY TO EXERCISE.

Physical exercise as an agent for the reduction of fat has been a very unsatisfactory procedure, because seven-eighths of the fat individuals are too lazy to exert themselves, which is largely due to the corpulency and helplessness, causing inactivity and favoring the further accumulation of fat. Very few will submit to a thorough course of physical exercise. Good results have been reported recently where the administration of certain drugs is in conjunction with exercise, gymnastic work, mountain climbing, swimming, or bicycling and all outdoor athletic games to promote oxidation.

Under the supervision of a competent physical director, and especially so where there is a medical adviser connected with the organization or college, overtraining seldom occurs. The individuals so affected usually practise according to their own ideas, or are misguided by an incompetent director, or they allow their enthusiasm and anxiety for a medal or whatever prize may be the reward, to predominate, no matter what may result later. A thorough physical examination should be the guide in all contests where great physical strength and endurance are demanded. This is to occur before and after a thorough course of training

in order to decide whether or not he is entitled to enter a contest. Especially so in long distance running, bicycle races, and heavy dumb-bell lifting.

A series of movements can, as before stated, be so arranged into regular lessons calculated to produce and maintain a normal development of the whole body, as follows:

A. For chest deformity and lung affections-Shoulder elevation, arm-circling, arm elevation and swinging, arm movements combined with breathing exercises, deep breathing, regular breathing; also in combination with wand movements, involving the muscles of the chest, back, shoulders, and neck. Indicated in: Asthma and chest deformities, lack of flexibility of the shoulder joints and adhesions, one-sided activity of the lungs, which can be corrected by the regular breathing, round and uneven shoulders.

B. For the improvement of disturbed abdominal functions and stimulation of the nerves and spine of the same region the following exercises are recommended:

The various movements of the trunk, thigh flexion, combination of trunk and arm movements, running with and without thigh and leg flexion, and the vast variety of leg movements involving the muscles, nerves, and organs of the respective regions. Indicated in Sluggish action of the portal system, liver, in fact, the whole alimentary tract, for weakened muscles throughout the entire region, due to disuse or lack of development, nervous stimulation and flexibility of the joints.

BEST TIME FOR GYMNASTICS.

Some authors are of the opinion that the exercises should always be taken about onehalf to one hour before meal time. Others advocate for the student, professional and business man: The best time for daily exercise is a half hour before meal at noon and between the hours of 4 and 6 p. m. It is so considered for the reason that the organs of digestion have performed their function and the system is supplied with a fresh amount

of nutrition. Then, too, the time is convenient for the above individuals. However, any hour during the day time and evening can be selected for exercise after a sufficient time has been allowed for digestion of the meal previously taken.

The writer has experienced that to exercise before breakfast requires a great deal more will power to work energetically than any other hour during the day or evening, because one is aroused during the day and ready for practice of any kind, and not so upon rising.

How soon after meals can exercise be indulged in? is a question frequently asked. Within an hour after meals one can begin exercise without any great interference to digestion; if the work is not too violent, digestion is favorably assisted.

How long during life ought one exercise? Exercise ought to begin at the age of 6 or 7 years and to be continued at regular intervals at least to maturity to secure the best results. If continued throughout life. such individuals are better fitted to perform their daily vocation and retain a more youthful appearance, better disposition, and activity at an advanced age as compared with one who does not exercise at all. Then, too, the system is more able to resist disease. -Mind and Body.

蛋蛋

HYGIENIC SELF-CULTURE.

BY JOHN HOOD, A.M., M.D., Baltimore, Maryland.

MAN'S life and character may be influenced but not necessarily dominated by the conditions in which he lives, and moves and works. In the education and culture of his spiritual, moral and mental powers, with due hygienic care of his physical organization, he becomes largely master of his circumstances, and thus rises higher than his environment. Now as man may personally attain a commanding position in his environment, personal hygiene, or hygienic self-cul

ture, should also have a permanent and prominent place in our investigation and practice of the laws of health.

"Perfect health-that is, abundant vital power capable of resisting all causes of disease or depression, and sustaining by sympathy the health, energy and spirits of others. -depends," says a great physiologist, "upon the large development and cultivation of the region of health and animation. It rerequires a large development of the shoulders and the crown of the head. The true science of health," he also says, "is connected with ethical or religious science and the performance of duties; and all hygienic science which rests in the physical alone will fall short of human needs. The emotional and spiritual part of man's nature is as important as the physical.

"First and preeminently we should cultivate the brain, and especially cultivate its higher powers-love, energy, duty, and persevering firmness-for the higher the culture the nobler and longer will be the life. These qualities sustain all the powers of life. and fill the body with healthy and joyous efficiency. They defy disease, despair and insanity. Consequently the first lesson of true. hygiene is love; the second is work, or energy; and the third is aspiration, or self-respecting ambition.

"There is no permanent and solid foundation of health and success without these higher qualities. Hence our hygienic law is: incessant industry in the society of our fellows, and the continued making of friends, which form the test of our active virtues. If we do not win love and friendship our moral capital is not in active use, and if we have not accomplished anything of value we are moral paupers. A life without enthusiasm is a poor affair. Greatness of soul is the only great success, and soulculture takes precedence of all other cultures. The brain should be warm. A coldbrained man is the one commonly called cold-hearted.

"The glowing condition of the brain is accompanied by a similar glowing condi

tion of the chest, and from these two comes the life that animates the entire person.

"Looking at the body we find the normal superiority of the chest, which in its upper portion corresponds to the upper half of the brain. From the thorax proceed the currents of richly vitalized blood, which supply all parts of the body with vitality. Hence if we would increase the stock of vitality we must increase the development and activity of the chest, which can be done only by a life of action. The idle man degenerates, the busy man develops. Degeneracy of the thorax implies degeneracy of the whole constitution.

The expansion of the chest indicates the expansion or development of the noblest elements of humanity, for the higher organs of the brain are in so close a relation to the chest that its development becomes to them an invigorating co-operation.”

Thoracic expansion should, therefore, be steadily sought by all, and when it cannot be obtained by active exertion it may be sought by the expansion of the chest in forced respiration. We should several times a day inflate the chest to its fullest capacity, holding the breath for ten or fifteen seconds, or more, and in walking we should accustom ourselves to inflate the chest and firmly hold the breath a few seconds, then making a gradual expiration and repeating the process a number of times.

This inflation should be made by the ascent of the ribs, not by the descent of the diaphragm. This mode of breathing tends to develop the thorax and diminish the prominence of the abdomen, thus giving a desirable form to the body, promoting the expansion of the lungs and improving the quality of the voice as well as the aeration of the blood. These systematic exercises in full breathing are regarded of great hygienic value in strengthening the nervous system and promoting the higher sentiments as well as in developing the muscular system and intensifying the vital powers.

The great benefit of high altitudes in developing a higher degree of health and a

more equable temperament is produced mainly through the expansion of the chest required by a rarer atmosphere and the more rapid exhalation from the lungs. This beneficient influence has been amply realized in the elevated portions of Colorado and New Mexico.

Patients have often cured themselves by an active outdoor life which greatly increases the respiration. "The question of curing the disease" (tuberculosis), says Prof Mays, "does not depend on the purity or freshness of the air, nor upon the number of bacilli which the atmosphere may contain, nor upon the amount of oxygen that may be introduced into the body, for these are secondary considerations, but it is simply a mechanical question, a question as to the best mode of expanding the lungs, and especially the apices of our round-shouldered and flat-chested patients, of removing the infiltrated products already existing, and of enhancing the constitutional resistance."

As an exercise for the promotion of health that of lung expansion should be continued until an expanded chest becomes habitual and permanent.

The importance of giving especial attention to the development of the lungs will be understood more clearly if we acquire a clear understanding of their functions. It is generally supposed that the chief work of the lungs is the separation of carbon dioxide from the blood and the introduction of oxygen. This, however, could be done by organs, it has been maintained, less than the size of the kidneys, and does not, therefore, account for the vast size of the lungs.

The main use of the lungs is to give to the human organism its power of action. This power exists in the atmospheric air, and the lungs are the medium by which and through which that power is conveyed into the organism. Where there is no air there is no action; and the consumption of air in any living organism is in exact proportion to its size and action. It is probable that in all animals the same amount of action requires exactly the same quantity of air.

As the object of respiration, therefore, is to give support to the nervous system and power to the muscular system, as well the purification of the whole organism by the elimination of carbon dioxide (with other effete matters) and the introduction of oxygen, the development of the lungs and their hygienic management are of primary importance, the utmost vigilance should be exercised in observing the condition of the air that we breathe, not only as to the proper lightness of the atmosphere but also as to its purity and electric conditions. There is also to be observed a depressing negative condition, produced by the absence of sunshine, by the evaporation from moist surfaces, and by the melting of ice or snow, which is oppressive to the lungs. This is said to be especially realized on the coast. of New England from the influence of Atlantic icebergs, and on the Lake Shores when the ice is beginning to disappear.

The lungs also have an important relation to the limbs. Cold applied to the limbs tends to congest and debilitate the lungs. A current of cold air against the ankles and legs tends to produce pulmonary disease. The entire surface of the limbs, therefore, need protection in order to protect the lungs. This remark is applicable to the upper part of the back. A Spanish proverb says: "He who stands with his back to the wind turns his face toward his grave."

Edward Checkley, of Brooklyn, an ingenious student of self-culture, is very enthusiastic concerning the value of thoracic expansion, especially of the upper portion of the chest. He observed in defective respiration a fruitful cause of disease. One class, with round shoulders and a stooping gait, with drooping heads and with more of abdominal than of costal respiration, be found inclined to consumption, heart disease, paralysis and dyspepsia. In another class that used the base of the lungs to the neglect of the upper portion, throwing the body backward and projecting the abdomen, he found tendencies to dropsy, hernia, apoplexy, paralysis, and kidney diseases. When the body is held erect, the muscles of the abdo