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Page 12
CHAPTER V.
REST.
I have said more than once in the early chapters of this little volume
that the treatment I wished to advise as of use in a certain range of
cases was made up of rest, massage, electricity, and over-feeding. I
said that the use of large amounts of food while at rest, more or less
entire, was made possible by the practice of kneading the muscles and by
moving them with currents able to effect this end. I desire now to
discuss in turn the modes in which I employ rest, massage, and
electricity, and, as I have promised, I shall take pains to give, in
regard to these three subjects, the fullest details, because success in
the treatment depends, I am sure, on the care with which we look after a
number of things each in itself apparently of slight moment.
I have no doubt that many doctors have seen fit at times to put their
patients at rest for great or small lengths of time, but the person who
of all others within my knowledge used this means most, and used it so
as to obtain the best results, was the late Professor Samuel Jackson. He
was in the habit of making his patients remain in bed for many weeks at
a time, and, if I recall his cases well, he used this treatment in just
the class of disorders among women which have given me the best results.
What these are I have been at some pains to define, and I have now only
to show why in such people rest is of service, and what I mean by rest,
and how I apply it.
In No. IV. of Dr. S�guin's series of American Clinical Lectures, I was
at some pains to point out the value of repose in neuralgias, and
especially sciatica, in myelitis, and in the early stages of locomotor
ataxia, and I have since then had the pleasure of seeing these views
very fully accepted. I shall now confine myself chiefly to its use in
the various forms of weakness which exist with thin blood and wasting,
with or without distinct lesions of the stomach, womb, or other organs.
Whether we shall ask a patient to walk or to take rest is a question
which turns up for answer almost every day in practice. Most often we
incline to insist on exercise, and are led to do so from a belief that
many people walk too little, and that to move about a good deal every
day is well for everybody. I think we are as often wrong as right. A
good brisk daily walk is for well folks a tonic, breaks down old
tissues, and creates a wholesome demand for food. The same is true for
some sick people. The habit of horse-exercise or a long walk every day
is needed to cure or to aid in the cure of disordered stomach and
costive bowels, but if all exertion gives rise only to increase of
trouble, to extreme sense of fatigue, to nausea, to headache, what shall
we do? And suppose that tonics do not help to make exertion easy, and
that the great tonic of change of air fails us, shall we still persist?
And here lies the trouble: there are women who mimic fatigue, who
indulge themselves in rest on the least pretence, who have no symptoms
so truly honest that we need care to regard them. These are they who
spoil their own nervous systems as they spoil their children, when they
have them, by yielding to the least desire and teaching them to dwell on
little pains. For such people there is no help but to insist on
self-control and on daily use of the limbs. They must be told to exert
themselves, and made to do so if that can be. If they are young, this
is easy enough. If they have grown to middle life, and created habits of
self-indulgence, the struggle is often useless. But few, however, among
these women are free from some defect of blood or tissue, either
original or acquired as a result of years of indolence and attention to
aches and ailments which should never have had given to them more than a
passing thought, and which certainly should not have been made an excuse
for the sofa or the bed.
Sometimes the question is easy to settle. If you find a woman who is in
good condition as to color and flesh, and who is always able to do what
it pleases her to do, and who is tired by what does not please her, that
is a woman to order out of bed and to control with a firm and steady
will. That is a woman who is to be made to walk, with no regard to her
complaints, and to be made to persist until exertion ceases to give rise
to the mimicry of fatigue. In such cases the man who can insure belief
in his opinions and obedience to his decrees secures very often most
brilliant and sometimes easy success; and it is in such cases that women
who are in all other ways capable doctors fail, because they do not
obtain the needed control over those of their own sex. I have been
struck with this a number of times, but I have also seen that to be too
long and too habitually in the hands of one physician, even the wisest,
is for some cases of hysteria the main difficulty in the way of a
cure,--it is so easy to disobey the familiar friendly attendant, so hard
to do this where the physician is a stranger. But we all know well
enough the personal value of certain doctors for certain cases. Mere
hygienic advice will win a victory in the hands of one man and obtain no
good results in those of another, for we are, after all, artists who all
use the same means to an end but fail or succeed according to our method
of using them. There are still other cases in which mischievous
tendencies to repose, to endless tire, to hysterical symptoms, and to
emotional displays have grown out of defects of nutrition so distinct
that no man ought to think for these persons of mere exertion as a sole
means of cure. The time comes for that, but it should not come until
entire rest has been used, with other means, to fit them for making use
of their muscles. Nothing upsets these cases like over-exertion, and the
attempt to make them walk usually ends in some mischievous emotional
display, and in creating a new reason for thinking that they cannot
walk. As to the two sets of cases just sketched, no one need hesitate;
the one must walk, the other should not until we have bettered her
nutritive state. She may be able to drag herself about, but no good will
be done by making her do so. But between these two classes, and allied
by certain symptoms to both, lie the larger number of such cases, giving
us every kind of real and imagined symptom, and dreadfully well fitted
to puzzle the most competent physician. As a rule, no harm is done by
rest, even in such people as give us doubts about whether it is or is
not well for them to exert themselves. There are plenty of these women
who are just well enough to make it likely that if they had motive
enough for exertion to cause them to forget themselves they would find
it useful. In the doubt I am rather given to insisting on rest, but the
rest I like for them is not at all their notion of rest. To lie abed
half the day, and sew a little and read a little, and be interesting as
invalids and excite sympathy, is all very well, but when they are bidden
to stay in bed a month, and neither to read, write, nor sew, and to have
one nurse, who is not a relative,--then repose becomes for some women a
rather bitter medicine, and they are glad enough to accept the order to
rise and go about when the doctor issues a mandate which has become
pleasantly welcome and eagerly looked for. I do not think it easy to
make a mistake in this matter unless the woman takes with morbid delight
to the system of enforced rest, and unless the doctor is a person of
feeble will. I have never met myself with any serious trouble about
getting out of bed any woman for whom I thought rest needful, but it has
happened to others, and the man who resolves to send any nervous woman
to bed must be quite sure that she will obey him when the time comes for
her to get up.
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