It need hardly be added, that, in the selection of any kind of exercise for those who are decidedly invalided, its adaptation, in kind and degree, to the nature of the complaint the patient is suffering from, should be especially attended to. It might seem to be evident enough, that when there is a much deranged or a diseased condition of any of the great organs, in the head, chest, or abdomen, any kind of violent exercise would be highly improper, and perhaps full of immediate risk;-that a disordered state of some of these organs admits of a nearer approach to violent exercise, than such a state of some of the other organs: for instance, that in many cases of disordered lungs, or liver, exercise on horseback is of the greatest use, and is perfectly safe ; while in many cases of disease of the encephalon or of the heart, exercise of so active a kind would be attended with considerable danger, and these cases would probably be most benefited by quiet and gentle walking, or by riding in an easy and open carriage ; that, in spinal cases, of severe character and degree, on the other hand, any sitting or standing posture might be very injurious; and a vehicle long enough to enable the patient to lie down on

principle already laid down, if not exceeding the point at which exercise promotes nutrition and increases strength, will serve as a safe guide on all occasions, and indicate the rate at which it may be extended. Old sportsmen know the rule by experience, and generally prepare themselves for the moors, by several weeks of previous training. The science and judgment which fox-hunters display in preparing their horses for their future exertions in coursing are well known, and might be still more usefully applied by their riders, to the training of their own families.”

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a mattress, with curtains, or glazed panels, that might be closed or opened at pleasure, so affording the invalid the benefit of exposure to the open air, and sufficient change of air, together with that of the perfectly passive exercise of the easy and rocking motion, might be the most suitable means of affording the needful exercise;—and, yet, although these matters are fully known and recognised, and many similar practical facts are scattered through medical works, and are matters of commonest observation, it is nevertheless quite true, that this question is much neglected in practice; and particulars as to the kind of exercise that should be made use of, and the extent to which it should be carried, if seldom asked for, are unquestionably as seldom entered into. It is quite certain that this should not be the case. Sir Benjamin Brodie, in some hints and suggestions as to the management and treatment of cases of distortion of the spine not connected with caries,* at once illustrates the importance of exercise as a remedial agent, and how much may be done by the exertion of his information and practised judgment on the part of the medical man, to guide and regulate the kind and degree of the exercise made use of. He says, "With a view to strengthen in particular the muscles of the back, particular exercises may be had recourse to; and many kinds of exercise have been contrived for this purpose. All climbing exercises are useful in this respect, bringing all the muscles of the spine into

* Vide Lancet, January 2, 1847.

vigorous action. They are at the same time beneficial in another way, the weight of the lower limbs tending to elongate and strengthen the column of the vertebræ. A rope with worsted wound round it, that it may not hurt the hands, may be suspended from the ceiling, and the patient will soon become a dexterous climber. There are often two or three girls in a family for whom this exercise will be beneficial; and that which would be a tedious and irksome task to a girl alone, will become an amusement when pursued in the company of others of her own age. The hand-swing affords a very useful exercise in these cases also. This is a triangle composed of a double rope, with a cross-bar of wood forming the base of the triangle, suspended from the ceiling at such a height, that the individual who uses it can just reach the cross-bar with her hands as she stands on tip-toe. She is to hold the bar with both her hands, and swing with her feet raised a little from the ground.* The effect of this exercise also is to bring the muscles of the spine into action, at the same time that the weight of the lower limbs operate in the same manner as when she climbs a rope. At first, probably, she will not be able to continue to use the hand-swing for more than a few seconds at a time; but as she grows stronger, she will swing for a much longer period. Another mode of exercising, and thus strengthening, the muscles of the back, is the following. Let one pulley be fixed to the ceiling,

* Vide supra, page 13.

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and another to the floor. Let a small rope pass over the upper pulley, and under the lower pulley, a box containing a light weight being fastened to that end of the rope which is nearest to the upper pulley, and a handle to that which is nearest to the lower pulley. The patient, standing with her face towards the pulleys, is to raise and lower the weight, holding the handle in both her hands. The effort used in raising the weight necessarily calls the muscles of the back into action, and as the patient becomes accustomed to it, the required effort may be increased by putting an additional weight into the box. This exercise may be varied by taking off the handle, and fixing the rope to a bandage fastened round the head, so that the weight is raised by the action of the muscles of the neck and back, without the aid of the arms. The latter method of using the pulleys, however, is wearisome to the patient, and, practically, much less useful than the other. I offer these as examples of the kind of exercise which may be supposed to be especially adapted to cases in which there is deficiency of power in the muscles of the spine. Understanding what is required, you may easily invent others equally efficacious. Those which I have described have the advantage of simplicity, and of being easily adopted in a private house. One or the other may be had recourse to according to circumstances; and it is better that the patient should practise her exercises at different periods of the day, rather than be exhausted by practising them for a

very long time at any one period. Anything like over-exertion should be carefully avoided."

How different this, in sound principle, and in correct pathology, and treatment founded on physiology, from the older management, or rather mismanagement, of such cases as these, by steel supports resting on the pelvis, extending to the axillæ, and sometimes to the occiput, by which the straightness and strength of the spinal column were endeavoured to be restored, in defiance of the physiological law,—that muscles are powerful for their offices in the economy, in proportion to the health of the system generally, and to the degree of use which is made of them! How different is this, from the absurd contrivances, even now not discarded universally, by which it has been endeavoured to maintain or restore the straightness of the spinal column by attaching weights to the shoulders; or to secure an erect carriage, and drooping shoulders, and a flat back, by an apparatus with arm-holes, which fitted on to the shoulders, and was tightly laced between the scapula;-how different from another of the means that used to be so commonly had recourse to, of effecting these same intentions: putting a weight, which might be considerable or might be small, on the top of the head, which, according to circumstances, was to be worn and maintained in its place during a certain time of every day, or carried a longer or shorter distance, - the maintaining the head duly level being of course necessary, to prevent the