Physical Culture as a Therapeutic Agent.

BY C. E. BLACK, M.D.,

Jacksonville, Ill.

[HIS subject has not been selected with the expectation of being able to present anything new or original, but to state a few well-known physiological facts, and from these facts to make deductions which seem naturally to follow, if our physiology is correct. If the importance of physical exercise in maintaining good health can be fully presented, the object of this paper will be accomplished. So many so-called systems have been advertised and worked as cure-alls that the people have come to distrust them.

It behooves the medical profession to become an educator in the importance of physical exercise to develop health. Even those who have given some attention to the value of physical exercise as a therapeutic agent often have very indefinite ideas of how to prescribe it, and have no system which is readily adapted to the various demands. No good result can come from the careless following the careless advice. The physician should be able to as readily prescribe exercise for those needing it as to prescribe drugs. Of course, exercise can no more replace drugs and other therapeutic agents in the treatment of diseases than can drugs. alone be relied upon to cure every ailment.

Many of the ills of humanity can come from faulty physical development due to neglected or perverted physical exercise. A discussion of the general question of physical exercise with a consideration of its value as a therapeutic agent should be profitable. We are frequently consulted by patients whose physique is unable to bear the continued strain to which it is subjected by their habits and occupations. Another class of patients is that in which the physique receives so little use in exercise that there is physical degeneration, and the vital organs are not receiving sufficient stimulation.

In ancient Greece the training of the body was an important part of the education of every youth. The result of the physical education was plainly visible in the whole nation, in which symmetry and beauty of physique were the rule rather than the ex

ception. Although the primary object of this training was for military purposes, still the Greeks fully recognized a therapeutic value in systematic physical exercise, as is shown by their division of gymnastics into (1) gymnastica militaria and (2) gymnastica medica. As soon as the regular work in the gymnasia gave way to effeminate manners, the hardy vigor of the Greek life began to decline and the nation to lose its power.

Rome imitated the gymnasia of the Greeks, but did not perfect them as a part of her educational system. France had the tournaments, which were much patronized at one time, but declined with chivalry. Modern gymnastics had their beginning in the latter part of the eighteenth century in Germany, and were considerably systematized in the early part of the present century by one Jahn. The first gymnasium was opened in this country at Northampton, Mass., by Dr. Beck, in 1825. The modern gymnasium, with its improved and delicately graduated apparatus, offers one of the most useful methods of prescribing to our patients regular graduated and systematic exercise.

The following definition of exercise given by DuBois Reymond, Professor of Physiology in the University of Berlin, will help us better to comprehend what is meant by physical exercise. He says, "By exercise we commonly understand the frequent repetition of more or less complicated action of the body with the co-operation of the mind, or of an action of the mind alone, for the purpose of being able to perform it better."

There is one element of exercise which is not expressed in this definition. All true exercise must overcome some resistance, -that is, it must have in view the accomplishment of something more than simply the movement of the frame to which the muscles are attached. We may have movement without exercise in its scientific sense. The muscles will not be developed by movements which do not overcome some resistance. The highest endowment of the human economy is to labor,-to overcome the natural resistance which nature has put in man's pathway. It is only as we overcome resistance that we are developed. Exercise is a form of voluntary labor. With the addition of the element of resistance this definition covers all kinds of exercises both physical and mental. While we have to do in this paper with physical exercise, yet the two are so intimately related that it is impossible to separate them, and a definition to be comprehended must consider both.

It will be necessary to give some attention to the physiology of exercise, and in order to do this the general anatomical and physiological characteristics of the muscles and nerves must be briefly reviewed.

The muscles of the human body are of two kinds, -invol. untary or unstriped and the voluntary or striped. The involuntary muscles are not definitely under the control of the will and are found in those parts which act independently of the will power. They consist of "elongated, spindle-shaped, nucleated fibre-cells, which, in their perfect form, are flat, from about 1-4500 to 1-3500 of an inch in length, very clear, granular, and brittle, so that where they break they often have abruptly rounded or square extremities. Each muscle cell consists of a fine sheath, probably elastic, of a central bundle of fibrils representing the contractile substance, and of an oblong nucleus which includes within a membrane a fine net-work anastomosing at the poles of the nucleus with the contractile fibrils. The ends of the fibres are usually single, sometimes divided. Between the fibres is an albuminous cementing material in which are found connectivetissue corpuscles and a few fibres. The perimesium is the fibrous connective tissue surrounding and separating the bundles of the muscle cells." (Kirke.)

"The voluntary muscles consist of bundles of fibres called fasciculi, enclosed in a sheath of connective tissue. Each muscular fibre is thus constructed: Externally is a fine, transparent, structureless membrane called the sarcolemma, which in the form of a tubular investing sheath forms the outer wall of the fibre and is filled up with contractile material of which the fibre is chiefly composed. Sometimes, from its comparative toughness, the sarcolemma will remain untorn, when by extension the contained part can be broken and its presence is in this way best demonstrated. The fibres, which are cylindriform or prismatic, with an average diameter of about 1-500 of an inch, are of a pale yellow color, and apparently marked by fine striæ which pass transversely around them, in slightly-curved or wholly parallel lines. Each fibre is found to consist of broad dim bands of highly refractive substance representing the contractile portion of the muscle-fibre." (Kirke.)

The muscular fibres vary in length, but many fibres are necessary to constitute the length of most muscles. The fibres are joined together in bundles or fasciculi very much like rope made of

a large number of strings of sausages (Hartwell), to use a crude illustration. Each muscle terminates in a tough, inelastic fibrous band, by which it is attached to the bone. The thicker parts of the muscle contain the larger number of parallel fibres.

The muscles are freely supplied with blood-vessels and nerves. The vessels are distributed over the muscular fibres as capillaries, which do not enter the fibre, but are spread out over them for the distribution of oxygen and other nutrient material for the building up of the muscle.

In a state of rest muscular fibres have a perfect elasticity and may be considerably stretched, but always return to a perfect normal position. They are always more or less on the stretch, for if they were lax when not in activity much of their power would be lost in making themselves taut before any work of moving the body frame was begun. It is estimated that a cubic centimetre of muscle is capable of exerting a force equal to moving a weight of about twenty pounds.

The nerves which are distributed to the muscles divide up minutely for distribution to the muscular fibres. Each muscle is supplied with both motor and sensory nerves. The nerves to the involuntary muscles are chiefly from the ganglionic or sympathetic system, and those to the voluntary muscles from the cerebrospinal system.

The nervous system has two principal divisions, the cerebrospinal and the sympathetic; and the nerve-fibres are of two varieties, the medullated or the white fibres, and the non-medullated or the gray fibres. In most nerves we find both bound up together, so that the motor and sensory impressions are conveyed by the same nerve, which consists of bundles of fibres. Each medullated fibre consists of a primitive sheath, the nucleated sheath of Schwann, a medullary sheath of white substance of Schwann, and an axis cylinder or axial fibre, which is made up of a large number of fibrillæ. The non-medullated nerves are much finer than the medullated, and there is an absence of white substance.

All nervous impressions have their origin or termination directly or indirectly in the central nervous system, which is composed of nerve-fibres and nerve-cells. The brain has both motor and sensory centres, which control the various actions and impressions for the whole body.

Expressed according to their function, nerves are either motor

or sensory. The motor nerves (efferent) convey impressions from the central system to the muscles, and the sensory nerves (afferent) convey impressions to the central system.

The human body has been appropriately called (Hartwell) a neuro-muscular machine for taking from the blood those parts which will build up the tissue; to relieve the system of those waste products which are generated by tissue activity, and for converting the potential energy of muscle and nerve cells into the energy of motion and stimulation and perception.

A muscle is not a simple organ, but is complex, being made up of a multitude of fibres, which are supplied with nerves and blood-vessels, all under the central nervous system.

Muscle is irritable, and responds to various stimuli. A muscle taken recently from the living body may be made to contract directly to a blow or other stimulus. The muscles of some of the cold-blooded animals, which have been the ones chiefly used in experiments, maintain their irritability for a considerable time after being removed from the body. In the body the nervous system is the natural stimulant by which the muscles are made to contract. It is the duty of the muscle to respond to the stimulus of the nervous system. The nervous system also has an irritability, and must respond to certain stimuli; but that response in a nerve is expressed in some other form than that of motion, as in pain or perception. In the cells of the central nerve organ it is determined that a certain muscle or group of muscles must be set in motion, and that impression is conveyed by motor or efferent nerves to the muscle, which responds by contracting, and thus setting the frame-work of the part in motion. As soon as this motion is begun, the sensory nerve is stimulated and conveys at once to the central organ the information of what has been done by the muscle.

As soon as the muscle begins to act, the capillaries and small vessels supplying that muscle dilate so as to convey more oxygen and other nutriment to the muscle to strengthen and fit it for work and to take away the carbonic acid and other waste products. The heart's action is quickened in response to a greater demand for arterial blood, and the lungs are expanded by the demand for more rapid oxygenation of the blood and the throwing off of the carbonic acid. The skin, kidneys, and other organs also have greater demands made on them for the disposal of waste products.

Exercise not only develops the voluntary muscles, but as it