Il8 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 63 



The dose of exercise is increased or diminished as the temperature 

 chart, pulse rate and other indications suggest. A colored badge is 

 given to the patient to denote the stage he has reached. 



I. Resting Stage, as noted above. (White Badge.) 



II. Stage of Regulated Exercises. (Yellow Badge.) This includes (i) 

 walking % to S miles; (a) on the level; (b) on sloping ground. (2) Various 

 respiratory exercises once or twice a day. (3) Other forms of movements 

 to improve carriage of shoulders, head, chest, etc. 



III. Stage of Regulated Work. (Pale Blue Badge.) 



IIIA. Picking up papers, leaves and other light rubbish on the grounds; 

 knitting; sewing; drawing. 



IIIB. (Green Badge.) Emptying waste garden boxes and assisting to carry 

 away rubbish. Carrying light baskets for various garden purposes. Light 

 painting work, wiping shelters ; setting tables and laying cloth in patients' 

 dining room; cleaning silver, brasses, taps, etc. 



inc. (Deep Blue Badge.) Raking, hoeing; mowing; sweeping leaves; 

 light wheel-barrow ; heavier painting work ; sweeping shelters ; scrubbing 

 floors ; cleaning knives ; assisting in laundry ; washing dishes. 



HID. (Red Badge.) Digging; sawing; carrying heavy baskets for various 

 gardening purposes; wheeling and drawing full wheel-barrow and other 

 heavy gardening work. Window cleaning and polishing floors ; sweeping 

 and cleaning court yard. Carpentering; joinering; engineering; attending 

 boiler; errands. 



An institution providing diversified occupations has a great advan- 

 tage over one w^hose patients are restricted to walking exercises and 

 where the women are employed in kitchen work and the men as 

 laboratory orderlies, assistants in the drug rooms, clerks and so on. 

 It is well to vary the walking exercise with manual labor. Patients 

 welcome it and take a great interest in the various occupations they 

 are put to. They acquire confidence in themselves as they see their 

 muscular tone improving and some prospect of resuming useful 

 occupations. 



With various modifications suggested by local conditions the sys- 

 tem of graduated labor described above is now adopted at various 

 institutions in America ; in many cases, however, the economic aspect 

 of the plan of treatment apparently overshadows the therapeutic 

 features ; probably the best examples of the method are at the Loomis 

 Sanatorium, New York, Otisville State Sanatorium, New York, The 

 Adirondack Cottage Sanitarium, New York, The North Reading 

 State Sanatorium, Massachusetts, and The Barlow Sanatorium, Los 

 Angeles, California. Dr. Barlow has kindly sent me the following 

 description of the method he has carried out : 



This institution is semi-charitable and re^ceives cases in all stages. 

 You ask me to send you a statement of our use of graduated labor. I will 

 give you the facts as we handle the matter, which is somewhat modified to 



