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Page 13
I have, of course, made use of every grade of rest for my patients, from
repose on a lounge for some hours a day up to entire rest in bed. In
milder forms of neurasthenic disease, in cases of slight general
depression not properly to be called melancholias, in the lesser grades
of pure brain-tire, or where this is combined with some physical
debility, I often order a "modified" or "partial rest." A detailed
schedule of the day is ordered for such patients, with as much
minuteness of care as for those undergoing "full rest" in bed. Here the
patient's or the household's usual hours may be consulted, a definite
amount of time allotted to duties, business, and exercise, and certain
hours left blank, to be filled, within limits, at the patient's
discretion or that of the nurse.
So many nervous people are worried with indecision, with inability to
make up their minds to the simplest actions, that to have the
responsibility of choice taken away greatly lessens their burdens. It
lessens, too, the burdens which may be placed upon them by outside
action if they can refuse this or that because they are under orders as
to hours.
The following is a skeleton form of such a schedule. The hours, the
food, the occupations suggested in each one will vary according to the
sex, age, position, desires, intelligence, and opportunities of the
patient.
7.30 A.M. Cocoa, coffee, hot milk, beef-extract, or hot water. Bath
(temperature stated). Rough rub with towel or flesh-brush: bathing and
rubbing may be done by attendant. Lie down a few minutes after
finishing.
8.30 A.M. Breakfast in bed. (Detail as to diet. Tonic, aperient, malt
extract as ordered.) May read letters, paper, etc., if eyes are good.
10-11 A.M. Massage, if required, is usually ordered one hour after
breakfast; or Swedish movements are given at that time. An hour's rest
follows massage. Less rest is needed after the movements. (Milk or broth
after massage.)
12 M. Rise and dress slowly. If gymnastics or massage are not ordered,
may rise earlier. May see visitors, attend to household affairs, or walk
out.
1.30 P.M. Luncheon. (Malt, tonic, etc., ordered.) In invalids this
should be the chief meal of the day. Rest, lying down, not in bed, for
an hour after.
3 P.M. Drive (use street-cars or walk) one to two and a half hours.
(Milk or soup on return.)
7 P.M. Supper. (Malt, tonic, etc., ordered; detail of diet.)
Bed at 10 P.M. Hot milk or other food at bedtime.
This schedule is modified for convalescent patients after rest-treatment
by orders as to use of the eyes: letter-writing is usually forbidden,
walking distinctly directed or forbidden, as the case may require. It
may be changed by putting the exercise, massage, or gymnastics in the
afternoon, for example, and leaving the morning, as soon as the rest
after breakfast is finished, for business. Men needing partial rest may
thus find time to attend to their affairs.
If massage is not ordered, there is nothing in this routine which costs
money, and I have found it apply usefully in the case of hospital and
dispensary patients.
In carrying out my general plan of treatment in extreme cases it is my
habit to ask the patient to remain in bed from six weeks to two months.
At first, and in some cases for four or five weeks, I do not permit the
patient to sit up, or to sew or write or read, or to use the hands in
any active way except to clean the teeth. Where at first the most
absolute rest is desirable, as in cases of heart-disease, or where there
is a floating kidney, I arrange to have the bowels and water passed
while lying down, and the patient is lifted on to a lounge for an hour
in the morning and again at bedtime, and then lifted back again into the
newly-made bed. In most cases of weakness, treated by rest, I insist on
the patient being fed by the nurse, and, when well enough to sit up in
bed, I order that the meats shall be cut up, so as to make it easier
for the patient to feed herself.
In many cases I allow the patient to sit up in order to obey the calls
of nature, but I am always careful to have the bowels kept reasonably
free from costiveness, knowing well how such a state and the efforts it
gives rise to enfeeble a sick person.
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