NO. I AIR AND TUBERCULOSIS — HINSDALE IIQ 



meet the needs of our institution. It seems to me that every institution must 

 modify this according to the facilities at command. Our working plan is as 

 follows : 



All the patients without any fever are kept absolutely quiet for the first 

 two or three weeks, except that they are allowed to go to the dining room 

 for meals. If, during this time, there is no elevation of temperature, no 

 marked acceleration of pulse, and no loss of weight, they are started on exer- 

 cise, beginning with ten minutes' walking twice a day. If they continue to do 

 well, gain weight, temperature remains normal, and progress of physical signs 

 is favorable, then exercise is increased every two weeks. The amount of 

 exercise is charted for each patient ; one copy posted on the bulletin board, 

 and one copy retained by the nurse in charge of the order, to check up the 

 allowance for each patient. Patients who have more than ten minutes' exer- 

 cise twice a day make their own beds and keep their rooms in order, except 

 the heavy cleaning. After patients have reached an allowance of thirty 

 minutes twice a day, they are assigned to more practical work about the 

 place or grounds. In making these assignments, the patient's physical condi- 

 tion and progress, former, and probably future, occupation are considered. 

 Most of these assignments are changed each month, the effort being to try to 

 increase the work each month. The work done includes the setting of tables 

 in the dining room, removing and washing dishes, work in the diet kitchen, 

 looking after books and pamphlets in the library, cataloguing books, statisti- 

 cal work, stenography and typewriting, carrying mail, light repairs about 

 buildings, care of paths and summer-houses, sprinkling during dry weather, 

 and operating the incinerator. Many patients are assigned to flower beds of 

 their own, or to doing light work in caring for the sanatorium grounds. In 

 carrying out this exercise or labor, careful watch is kept over patients, and 

 if any elevation of temperature, acceleration of pulse, or extension of physical 

 signs are observed, they are put back to rest. The purposes that this exercise 

 and labor seem to serve are, recreation, stimulating the appetite and digestion, 

 building up healthy tissue, inducing healthy sleep, and testing the patients 

 against relapses when they resume their normal way of living after being dis- 

 charged. We find that patients who accept the occupation cheerfully make 

 better progress mentally and physically than those who resent being assigned 

 to duties. 



For patients with an elevation of temperature 99° or over, acceleration of 

 pulse, either loss or no gain in weight, or who do not show improvement in 

 other ways, rest is continued, and exercise or assigned work is deferred. 



At the present time (December 11, 1913), there are 43 patients in the 

 sanatorium. Ten are in the infirmary ; thirty-three in open-air cottages ; of 

 the latter twenty-seven are doing their own work, and twenty-five additional 

 assigned work. Of the six in open air cottages not doing their own work, 

 three are new patients who have been recently admitted and not under obser- 

 vation a sufficient time for report. 



REFERENCES TO WORKS ON EXERCISE AND WORK 



Sir Robert W. Philip: Rest and Movement in Tuberculosis (British Medi- 

 cal Journal, December 24, 1910). 



Albert Robin: How Consumption is Cured by Work (Therapeutic Gazette, 

 December, 191 1, p. 854-865). 



