Il6 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 63 



cises intelligently, but groped in the dark, never dreaming of the 

 underlying principles as explained by laboratory studies of Sir Alm- 

 roth Wright, Paterson, Inman, and others. We trust that further 

 studies and the application of the same method in Europe and 

 America will fix the value of exercise in tuberculosis. 



A somewhat similar system of graduated labor has been adopted 

 in the King Edward VII Sanatorium near Midhurst, England. 

 Light work in the gardens and grounds is prescribed in lieu of some 

 of the walking exercise and forms part of the regular treatment. 

 Practical gardening in the grounds and flower beds is utilized. The 

 lightest labor consists of weeding, hoeing and edging paths and bor- 

 ders, gathering seeds, plucking dead flowers, pruning, etc. Some- 

 what harder exercise consists in wheeling soil to the lawns and 

 spreading it, clearing ground of stones and taking them away in 

 barrows, and in leveling new ground after being broken up. The 

 heaviest work is that of digging and trenching unbroken ground, 

 moving, rolling, etc. Paths through the pine woods have also been 

 constructed. In this particular work the breaking up of the ground 

 with picks and clearing away the roots from neighboring trees was 

 allotted to the first division of patients. The second division cleared 

 away the broken ground and roughly leveled it. The third division 

 finished the leveling of the paths with rakes and tidied up the edges.* 



Free patients at the King's Sanatorium have made a cinder tennis 

 court ; they have cut down and sawed fire wood ; they have an open 

 air carpenter shop and an instructor in carpentry, who is himself a 

 patient ; they care for the poultry and make the runs for the fowls. 

 In this way patients are constantly occupied. 



Although the system of graduated exercises, or labor, adopted 

 at the sanatoria referred to, has attracted wide notice and its princi- 

 ples were there first placed on a highly scientific basis, there were 

 previous attempts to do this in an intelligent and rational manner. 

 Sir Robert Philip, at Edinburgh, over twenty years ago, before the 

 bacteriology of tuberculosis had been so well developed, prescribed 

 practically the same thing as a therapeutic measure of definite dos- 

 age. He had had classes of selected patients who came at fixed 

 hours to take regular training with regard to posture and healthy 

 respiratory movement. More especially the young were taught the 

 value of a healthy form of chest, the principles of nose-breathing 

 and full diaphragmatic movement. " In addition to this, meas- 

 ured walks of varying amount and gradient were prescribed exactly 



* Noel Dean Bardswell, Tuberculosis, Berlin, May, 1908. 



