NO. I AIR AND TUBERCULOSIS — HINSDALE III 



CHAPTER VIII. EXERCISE IN TUBERCULOSIS; GRADUATED 



LABOR 



The Nordrach system of treatment of pulmonary tuberculosis car- 

 ried out by Dr. Walther and that of his predecessor, Dr. Brehmer, 

 at Goebersdorf, in Silesia, involves much exercise in addition to 

 fresh air and alimentation ; the Dettweiler system enjoins rest in 

 the open air with superalimentation. McLean's dictum is: " If the 

 phthisical patient would live, he must work for it." ^ Probably this 

 advice should not be taken too literally, at least by every tuberculous 

 patient ; but graduated physical exercise has a very important and 

 useful place in the treatment of most patients. Brehmer advocated 

 hill-climbing, while Walther advises graduated walking exercises, 

 in some cases to the extent of walking twenty miles a day. Whether 

 one practices walking, or hill-climbing or graduated labor, we cannot 

 dissociate from these measures the effect of atmospheric air, in its 

 various qualities, upon the lungs and the accompanying stimulation of 

 the pulmonary and general circulation. Two recent papers by London 

 practitioners are full of such suggestive thoughts on this subject that 

 we call special attention to them. They are considered by some as 

 marking an epoch in the treatment of pulmonary tuberculosis. 



At a meeting of the Medical Society of London, January 13, 1908, 

 Dr. Marcus S. Paterson, the Medical Superintendent of the Bromp- 

 ton Hospital Sanatorium, at Frimley, read a paper on " Graduated 

 Labor in Pulmonary Tuberculosis " which was supplemented by an- 

 other on the " Effect of Exercise on the Opsonic Index of Patients 

 Suffering from Pulmonary Tuberculosis," by Dr. A. C. Inman, Super- 

 intendent of the Laboratories, Brompton Hospital.* 



The patients for whom Paterson instituted graduated labor were 

 selected cases sent from the Brompton Hospital in London to its 

 Sanatorium at Frimley, at an elevation of 380 feet in the country. 



He was induced to carry out this plan of treatment after seeing 

 tuberculous patients who did well while working under unfavorable 

 surroundings ; but he believed that under careful regulation of labor 

 and with very careful observation of the temperature records, he 

 might safely proceed. The exercises adopted involved all the 

 muscles of the trunk and extremities and this was thought to be 

 better than walking exercises in which the lower limbs were chiefly 

 employed. The use of the upper limbs seemed more likely to favor 



^ McLean : Personal Observation in Phthisis Pulmonalis (Journal Amer. 

 Med. Ass., February, 1898). 

 ^ The Lancet, January 25, 1908. 



