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 excitement 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 principles 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 progressively 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 training, 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 stimulate, or to distribute and proportion mental action; and certain exercises may be abstained from to deprive certain areas of stimulation. 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 exercises. 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, telegrapher's, and piano-player's cramp, and similar troubles, characterized 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
