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Page 14
The daily sponging bath is to be given by the nurse, and should be
rapidly and skilfully done. It may follow the first food of the day, the
early milk, or cocoa, or coffee, or, if preferred, may be used before
noon, or at bedtime, which is found in some cases to be best and to
promote sleep.
For some reason, the act of bathing, or even the being bathed, is
mysteriously fatiguing to certain invalids, and if so I have the general
sponging done for a time but thrice a week.
Most of these patients suffer from use of the eyes, and this makes it
needful to prohibit reading and writing, and to have all correspondence
carried on through the nurse. But many neurasthenic people also suffer
from being read to, or, in other words, from any prolonged effort at
attention. In these cases it will be found that if the nurse will read
the morning paper, and as she does so relate such news as may be of
interest, the patient will bear it very well, and will by degrees come
to endure the hearing of such reading as is already more or less
familiar.
Usually, after a fortnight I permit the patient to be read to,--one to
three hours a day,--but I am daily amazed to see how kindly nervous and
an�mic women take to this absolute rest, and how little they complain of
its monotony. In fact, the use of massage and the battery, with the
frequent comings of the nurse with food, and the doctor's visits, seem
so to fill up the day as to make the treatment less tiresome than might
be supposed. And, besides this, the sense of comfort which is apt to
come about the fifth or sixth day,--the feeling of ease, and the ready
capacity to digest food, and the growing hope of final cure, fed as it
is by present relief,--all conspire to make most patients contented and
tractable.
The intelligent and watchful physician must, of course, know how far to
enforce and when to relax these rules. When it is needful, as it
sometimes is, to prolong the state of rest to two or three months, the
patient may need at the close occupation of some kind, and especially
such as, while it does not tax the eyes, gives the hands something to
do, the patient being, we suppose, by this time able to sit up in bed
during a part of the day.
The moral uses of enforced rest are readily estimated. From a restless
life of irregular hours, and probably endless drugging, from hurtful
sympathy and over-zealous care, the patient passes to an atmosphere of
quiet, to order and control, to the system and care of a thorough nurse,
to an absence of drugs, and to simple diet. The result is always at
first, whatever it may be afterwards, a sense of relief, and a
remarkable and often a quite abrupt disappearance of many of the nervous
symptoms with which we are all of us only too sadly familiar.
All the moral uses of rest and isolation and change of habits are not
obtained by merely insisting on the physical conditions needed to effect
these ends. If the physician has the force of character required to
secure the confidence and respect of his patients, he has also much more
in his power, and should have the tact to seize the proper occasions to
direct the thoughts of his patients to the lapse from duties to others,
and to the selfishness which a life of invalidism is apt to bring
about. Such moral medication belongs to the higher sphere of the
doctor's duties, and, if he means to cure his patient permanently, he
cannot afford to neglect them. Above all, let him be careful that the
masseuse and the nurse do not talk of the patient's ills, and let him by
degrees teach the sick person how very essential it is to speak of her
aches and pains to no one but himself.
I have often asked myself why rest is of value in the cases of which I
am now speaking, and I have already alluded briefly to some of the modes
in which it is of use.
Let us take first the simpler cases. We meet now and then with feeble
people who are dyspeptic, and who find that exercise after a meal, or
indeed much exercise on any day, is sure to cause loss of power or
lessened power to digest food. The same thing is seen in an extreme
degree in the well-known experiment of causing a dog to run violently
after eating, in which case digestion is entirely suspended. Whether
these results be due to the calling off of blood from the gastric organs
to the muscles, or whether the nervous system is, for some reason,
unable to evolve at the same time the force needed for a double
purpose, is not quite clear, but the fact is undoubted, and finds added
illustrations in many of the class of exhausted women. It is plain that
this trouble exists in some of them. It is likely that it is present in
a larger number. The use of rest in these people admits of no question.
If we are to give them the means in blood and flesh of carrying on the
work of life, it must be done with the aid of the stomach, and we must
humor that organ until it is able to act in a more healthy manner under
ordinary conditions. It may be wise to add that occasional cases of
nervousness or of nervous disturbance of digestion are seen in which the
patient assimilates food better if permitted to move about directly
after a meal; and I recall one instance of very persistent gastric
catarrh where the uncomfortable symptoms following meals only began to
disappear when as an experiment the patient was ordered to take a quiet
half-hour's stroll after each meal, instead of the rest usually ordered.
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