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Page 15
I am often asked how I can expect by such a system to rest the organs of
mind. No act of will can force them to be at rest. To this I should
answer that it is not the mere half-automatic intellectuation which is
harmful in men or women subject to states of feebleness or neurasthenia,
and that the systematic vigorous use of mind on distinct problems is
within some form of control. It is thought with the friction of worry
which injures, and unless we can secure an absence of this, it is vain
to hope for help by the method I am describing. The man harassed by
business anxieties, the woman with morbidly-developed or ungoverned
maternal instincts, will only illustrate the causes of failure. Perhaps
in all dubious cases Dr. Playfair's rule is not a bad one, to consider,
and to let the patient consider, this mode of treatment as a hopeful
experiment, which may have to be abandoned, and which is valueless
without the cordial and submissive assistance of the patient.
The muscular system in many of such patients--I mean in ever-weary, thin
and thin-blooded persons--is doing its work with constant difficulty. As
a result, fatigue comes early, is extreme, and lasts long. The demand
for nutritive aid is ahead of the supply, or else the supply is
incompetent as to quality, and before the tissues are rebuilded a new
demand is made, so that the materials of disintegration accumulate, and
do this the more easily because the eliminative organs share in the
general defects. And these are some of the reasons why an�mic people are
always tired; but, besides this, all real sensations are magnified by
women whose nervous systems have become sensitive owing to a life of
attention to their ailments, and so at last it becomes hard to separate
the true from the false, and we are thus led to be too sceptical as to
the presence of real causes of annoyance. Certain it is that rest, under
proper conditions, is found by such sufferers to be a great relief; but
rest alone will not answer, and it is needful, as I shall show, to bring
to our help certain other means, in order to secure all the good which
repose may be made to insure.
In dealing with this, as with every other medical means, it is well to
recall that in our attempts to help we may sometimes do harm, and we
must make sure that in causing the largest share of good we do the least
possible evil.
"The one goes with the other, as shadow with light, and to no
therapeutic measure does this apply more surely than to the use of rest.
"Let us take the simplest case,--that which arises daily in the
treatment of joint-troubles or broken bones. We put the limb in splints,
and thus, for a time, check its power to move. The bone knits, or the
joint gets well; but the muscles waste, the skin dries, the nails may
for a time cease to grow, nutrition is brought down, as an arithmetician
would say, to its lowest terms, and when the bone or joint is well we
have a limb which is in a state of disease. As concerns broken bones,
the evil may be slight and easy of relief, if the surgeon will but
remember that when joints are put at rest too long they soon fall a prey
to a form of arthritis, which is the more apt to be severe the older the
patient is, and may be easily avoided by frequent motion of the joints,
which, to be healthful, exact a certain share of daily movement. If,
indeed, with perfect stillness of the fragments we could have the full
life of a limb in action, I suspect that the cure of the break might be
far more rapid.
"What is true of the part is true of the whole. When we put the entire
body at rest we create certain evils while doing some share of good, and
it is therefore our part to use such means as shall, in every case,
lessen and limit the ills we cannot wholly avoid. How to reach these
ends I shall by and by state, but for a brief space I should like to
dwell on some of the bad results which come of our efforts to reach
through rest in bed all the good which it can give us, and to these
points I ask the most thoughtful attention, because upon the care with
which we meet and provide for them depends the value which we will get
out of this most potent means of treatment.
"When we put patients in bed and forbid them to rise or to make use of
their muscles, we at once lessen appetite, weaken digestion in many
cases, constipate the bowels, and enfeeble circulation."[15]
When we put the muscles at absolute rest we create certain difficulties,
because the normal acts of repeated movement insure a certain rate of
nutrition which brings blood to the active parts, and without which the
currents flow more largely around than through the muscles. The lessened
blood-supply is a result of diminished functional movement, and we need
to create a constant demand in the inactive parts. But, besides this,
every active muscle is practically a throbbing heart, squeezing its
vessels empty while in motion, and relaxing, so as to allow them to fill
up anew. Thus, both for itself and in its relations to the areolar
spaces and to the rest of the body, its activity is functionally of
service. Then, also, the vessels, unaided by changes of posture and by
motion, lose tone, and the distant local circuits, for all of these
reasons, cease to receive their normal supply, so that defects of
nutrition occur, and, with these, defects of temperature.
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