Muscular activity must also be included in treatment by occupation. It as frequently satisfies the indications of psycho-therapeutics as it does those of physical therapeutics. Here also the individuality of the patient must, of course, be taken into account. All kinds of physical sport belong here, such as cycling, riding, skating, tennis, gymnastics, and likewise ordinary walking exercise. We need not hesitate to recommend rough work occasionally, and too great attention should not be paid to the question of its suitability to the patient's station in life. It is the man engaged in head-work who so often derives great mental benefit from physical labour - tree-felling, sawing, grass-mowing, for instance. Cutting down trees did the English statesman, Gladstone, an immense amount of good. The way in which muscular activity influences the patient's mind must be judged from the standpoint of psycho-therapeutics. Cycling, for instance, from both the mental and physical standpoint of therapeutics. The speed with which long stretches of ground are covered and the relatively small amount of muscular energy expended have a salutary effect on the consciousness.

Fiirbringer lays great value on the way in which the work is divided among the cerebral centres. "The cyclist whose attention is chiefly directed to the road and the surrounding country is compelled to make very great calls on the lower centres, the organs of sense, and as the heavy thoughts which cloud his brain disappear cuts off those factors that were depriving him of mental rest." To be able to rest from mental labour of an exhausting nature is certainly an essentially remedial factor in many cases. On the other hand, Monnier has rightly pointed out that many kinds of work - e.g., turning the ergostat, the "hygienic promenade," the use of dumb-bells, knitting and the like are not to the purpose, because they only exercise the lower cerebral centres. It is far better to attempt the cure of habitual abnormal activity of the brain by diverting the activity into centrifugal paths, and we should therefore select some kind of work that requires constant application of the attention and can only be carried out by the primary consciousness. Both authors are correct in their advice, though they seem to contradict one another somewhat. They entirely agree that a form of muscular activity should be chosen which has some definite object in view.

We should hardly think of using a treadmill, for instance, as a therapeutic agent, since its employment is aimless. Other kinds of labour may be of much greater use - even chopping up blocks of wood, for that produces tangible results.

Much attention is paid to praxi-therapeutics nowadays, especially in institutes. We have certainly here to distinguish between cases in which the patients have only to work a short time - e.g., an hour or two in the garden, and those in which the work constitutes the essential part of the treatment The latter form of treatment plays a great part in those institutions for nervous diseases among the poor which were first erected on Benda's recommendation. The form of ergo-therapeutics employed in such establishments is that recommended by Krafft-Ebing, Eulenburg, Mobius, but more especially by Grohmann and Schwarz. Its object is to render' the patient once more a useful member of society. The system is worked on economic principles, the patient's work being utilized for the benefit of the establishment, and a portion of the expenses are thereby covered. Quite recently, training patients to work has come to be looked on as an essentially remedial factor even in establishments for those who are better off. Marcinowski deserves special mention in this respect. Although great importance must be ascribed to the use of ergo-therapeutics outside such institutions, the latter afford special advantages for its employment.

The supervision is very much better, provided the doctor really troubles about his patients and does not conduct the establishment as though it were merely an hotel. Monnier very properly insists that only a few patients at a time should be placed under the guidance of a specially qualified director, otherwise the treatment degenerates only too easily into a mere matter of routine. Very much depends on the personality of the director, who must understand how to permanently increase the patient's trust in himself and his confidence that his morbid symptoms are disappearing, by advice and suggestive influence. Such institutions are also specially adapted for praxi-therapeutic treatment, because good example is just as infectious as bad. A patient will be much more inclined to work when he sees others employed, and also observes how well their work makes them feel. As a rule no compulsion is necessary, and Mobius would even forbid the use of any such in an institute. It is generally quite unnecessary, because patients who are at first disinclined to work very soon follow the good example given them.

With regard to the curative value of work, views differ somewhat according to the results achieved. Although any differences in the results obtained may partly be due to the doctor, the nature of the disease also conditions such diversities. Schwarz has pointed out that better effects are produced with nervous people than with psychopathies. Monnier has attempted to make the indications even more definite. It is specially in quite fresh cases of hysteria that imperative ideas and impulses, tendency to brooding and auto-suggestion, paresthesiae of all kinds and the like, also the phenomena of neurasthenia, can be removed. Where the patients are weak-minded, psychopaths, or drunkards, the results depend essentially on hereditary disposition and the duration of the disease. To succeed in training such people to work has the very best influence not only on the patient himself but on his companions as well. The work-cure is not so beneficial in cases of hypochrondiasis and paranoia; in the former, restlessness and the constant desire for change, and in the latter the persecutory ideas, prevent the patients from persisting in the treatment.