112 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 63 



the. expansion of the lungs. It was not forgotten that the common 

 objections to this plan of treatment are, (i) that the disease would 

 become active again under the strain; and (2) that the exertion 

 would tend to produce hemoptysis. Considerable tact and personal 

 influence must have been exerted to get the patients to carry out a 

 plan which involved increasing labor and measures that are generally 

 considered positively harmful. 



The first exercise ordered was walking, the distance being gradu- 

 ally increased up to ten miles a day. When a patient had reached 

 this stage he was given a basket in which to carry mould for spread- 

 ing on the lawns. No case of hemoptysis or of pyrexia occurred 

 among these patients. When they had been on this grade with noth- 

 ing but beneficial results for from three weeks to a month, they 

 were given boys' spades with which to dig for five minutes followed 

 by an interval of five minutes for a rest. After a few weeks, several 

 of the patients on this work, who were doing well, were allowed to 

 work as hard as possible with their small spades without any inter- 

 vals for rest. As they had all improved on this labor larger shovels 

 were obtained, and it was found that the patients were able to use 

 them without the occurrence of hemoptysis or a rise of temperature. 

 About this time many of the patients were feeling so well that it be- 

 came necessary to restrain them from doing too much. 



These results in a few cases creates a most favorable sentiment 

 among the other patients so that the system was extended generally, 

 with great care and minute supervision. Harder work was pre- 

 scribed for patients who could be trusted even to the use of spades, 

 shovels and five "pound pick-axes. The patients all expressed the 

 opinion that the work did them good and that the harder they 

 worked the better they felt. Many patients have written to Dr. 

 Paterson to say that they date their improvement from the com- 

 mencement of the labor, and that they think the hardest work did 

 them the most good. It certainly speaks well for the strict supervision 

 of these patients that no accidents occurred of a serious nature, 

 though several developed fever and, subsequently, pleurisy. One 

 patient was laid up for two months and was much worse at the end of 

 that time, though eventually he did well and returned to work, though 

 the extent of his disease was increased through overexertion. 



The suitability of cases for graduated labor rests on a very careful 

 physical examination, importance being laid on the general muscular 

 and physical development. Marked wasting and poor development 

 is, naturally, a bar to this method of treatment. The resisting power 



