412 POPULAR SCIENCE MONTHLY. 



moisture and taxing the respiratory capacity much more promptly 

 and completely and is more capable of regulation than any other form 

 of exertion, at least any which would be admissible. It is only pos- 

 sible for people relatively young or strong to begin in this way. Our 

 subject is polysarcia in people of advancing years, and hence greater 

 caution must be exercised in outlining activities than for younger folk. 

 The general principles of exercises given at the end of this paper need 

 not be repeated here, but should be read in connection with the 

 measures now to be outlined. In over-stoutness of late middle life, 

 accompanied by good health, it is essential to use first fairly active 

 increasing extensor movements with elasticizing measures, active and 

 passive stretchings, loosening up of the hip joints particularly, and 

 above all, thorough drill in regaining proper attitudes. This should 

 be followed by systematic, accurate training in breathing till a normal 

 capacity is attained, almost never found in stout people unless acquired 

 through teaching. In a paper elsewhere I have elaborated these 

 thoughts {Internat. Med. Magazine, July, 1901). 



When we have to do with the fat anemic person vastly more care 

 must be used. The heart in these cases is likely to be infiltrated by 

 fat and the muscular fibers clogged and inelastic, and must be taught 

 slowly to regain their contractile vigor. At first, climbing stairs under 

 direction is about as much as can be attempted, and any house will 

 serve, merely regulating the number of steps walked up and down 

 (both being of benefit) and the rate of speed carefully specified. 

 Tall office buildings serve admirably for the purpose. Polysarcia 

 is such a disabling condition that it is well worth prolonged remedial 

 efforts. Success is possible, and indeed always probable, within 

 limitations. The unaided efforts of the patient can readily lead 

 to harm, sometimes calamity. There is one essential rule in deal- 

 ing with the cases under consideration, and that is the time for 

 treatment can not be measured by weeks, should not be measured 

 by months and can only safely and satisfactorily be measured 

 by years. One instance will help to illustrate my point. I had a 

 gentleman under my care of sixty-one years of age, who had learned 

 to ride a bicycle before meeting me and found it impossible to use this 

 much because of the distress it produced in breathing. I saw him only 

 rarely at intervals of months, and advised him by letter chiefly in con- 

 nection with his own physician. He was advised to adopt the rule of 

 riding regularly but briefly on the level roads of his own country place. 

 After some months these short excursions produced no distress. In a 

 year's time he was able to start out upon the open roads, but was com- 

 pelled to dismount at every small rise of grade. In another year he 

 was able to ride up moderate grades on a good road. At the end of 

 the second year he was riding with comfort and pleasure. At the end 



