Whether the tobacco in a given patient shall be withdrawn absolutely, or only modified in amount, depends entirely on the individual case. As stated above, no rule can be laid down as to what is enough and what is too much. Theoretically, two or three cigars a day is moderate, and anything more than five cigars a day is excessive; even one cigar a day may be too much. MISCELLANEOUS DISTURBANCES SIMPLE HYPERTROPHY Like any other muscular tissue, the heart hypertrophies when it has more work to do, provided this work is gradually increased and the heart is not strained by sudden exertion. To hypertrophy properly the heart must go into training. This training is necessary in valvular lesions after acute endocarditis or myocarditis, and is the reason that the return to work must be so carefully graduated. When the heart is hypertrophied sufficiently and compensation is perfect, a reserve power must be developed by such exercise as represented by the Nauheim, Oertel or Schott methods. Anything that increases the peripheral resistance causes the left ventricle to hypertrophy. Anything that increases the resistance in the lungs causes the right ventricle to hypertrophy. The right ventricle hypertrophy caused by mitral lesions has already been sufficiently discussed. The right ventricle also hypertrophies in emphysema, after repeated or prolonged asthma attacks, perhaps generally in neglected pleurisies with effusion, in certain kinds of tuberculosis, and whenever there is increased resistance in the lung tissue or in the chest cavity. The term "simple hypertrophy" is generally restricted to hypertrophy of the left ventricle without any cardiac excuse--the hypertrophy by hypertension and hard physical labor. It is well recognized that it hypertrophies with hypertension and with chronic interstitial nephritis. It also becomes hypertrophied when the subject drinks largely of liquid--water or beer--and overloads his blood vessels and increases the work the heart must do. This kind of hypertrophy develops slowly because the resistance in the circulation is gradual or intermittent. In athletes and in soldiers who are required to march long distances, hypertrophy generally occurs. This hypertrophy, if slowly developed by gradual, careful training, is normal and compensatory. In effort too long sustained, especially in those untrained in that kind of effort, and even in the trained if the effort is too long continued, the left ventricle will become dilated and the usual symptoms of that condition occur. Such dilatation is always more or less serious. It may be completely recovered from, and it may not be. Therefore it proper understanding of the physics of the circulation by the medical trainer of young men to decide whether or not one should compete in a prolonged effort, as a rowing race, for instance, is essential. It is wrong for any young athlete to have an incurable condition occur from competition.