EXERCISE AS A REMEDY. 633 



tions for the proper application of exercise in its various forms of 

 manual training, sports, drill, gymnastics, and special exercises. 



As exercise is a fundamental factor in the development and 

 culture of the mind, it can be used to modify mental states, and 

 has most important general and special applications in many 

 nervous diseases. The repetition of rather gentle monotonous 

 movements, especially of the automatic or passive kind, tends to 

 allay mental excitement and nervous irritability. If the excite- 

 ment is of the active insistent type, more vigorous exercise of 

 duration to the point of fatigue may be beneficial, but should be 

 semi-automatic, like walking, cycling, or rowing. These prin- 

 ciples find a useful application in the treatment of insomnia. If 

 the patient is dull and apathetic, with sluggish circulation and 

 nutrition, exercises involving quickness and skill that is, a 

 more lively mental co-operation, like fencing, tennis, or boxing 

 should be used. In other cases the brain may need to be pro- 

 gressively trained through manual employments. The finer and 

 more delicately adjusted the movements the less their value as 

 muscular exercise, and the more the nerve centers are called into 

 play. Writing, sewing knitting, playing on instruments, and in 

 general the use of the hands mainly are valuable as mental train- 

 ing, but lack the beneficial general effects of vigorous exercise 

 of the more fundamental groups. From its action as a cerebral 

 sedative or tonic, exercise may be used as a means of influencing 

 certain definite areas in the centers, in order to soothe, to stimu- 

 late, or to distribute and proportion mental action ; and certain 

 exercises may be abstained from to deprive certain areas of stim- 

 ulation. We know no drug that acts mainly on the arm centers 

 or mainly on the leg centers, but we can with certainty bring 

 either of these centers into action by prescribing indicated exer- 

 cises. In an important group of neuroses due to the excessive 

 repetition of certain fine movements, usually of the accessory 

 kind, involving accurate co-ordination, such as writer's, teleg- 

 rapher's, and piano-player's cramp, and similar troubles, char- 

 acterized by local pain and inco-ordination, usually associated 

 with extreme mental anxiety, the hurtful practice should be 

 stopped and massage and more general exercises involving more 

 fundamental groups substituted. In another class of cases the 

 bedfast neurasthenics the nutrition must first be built up by 

 seclusion and systematic feeding, and the neuromuscular system, 

 both voluntary and involuntary, aroused and strengthened by 

 bathing, massage, and passive movements. Patients that would 

 be injured at first by attempts at active movements will thrive 

 on gentle passive movements of the arms and legs, and will soon 

 be actively co-operating. When sufficiently advanced they can 

 be taught to walk, and before they can do much at this they can 



VOL. XLVIII. 45 



