THE POSITION IN BED.
As well as when up and about, is a matter of importance to the sick or well. With the sick, the habit of “rounding up” to the disease is every way prejudicial. Consumptives are especially inclined to seek present ease to their ultimate hurt. It should be one of the aims, in “lung difficulties,” to increase the breadth of the chest in order to give more room for the expansion of the lungs; and this demands increased efforts to expand the lungs, and to push the shoulders back—gradually, very gradually, never to the extreme, but with steady persistence. No radical and immediate change must be looked for; none can be accomplished, in any direction, whether in the shape of the body, quality of lung tissue, or breathing power; but a gradual transformation may be inaugurated, and ensured by means of persistent effort, as the general health improves. It is best to lie, at least much of the time spent in bed, as nearly flat upon the back as possible, slightly inclining toward the side, or alternating between the two positions, with the head low; arms and legs “at ease,” the latter not drawn or “curled” up, but slightly relaxed. If the general regimen is strictly hygienic, the position as thus described will, so far from working any harm, prove of advantage—favoring free breathing, as well as the fullest rest of the body. Where there is shortness of breath and difficulty in
breathing, the patient is inclined to cultivate the habit of narrowing the shoulders, and so bolstering himself in bed as to still further shorten the breath, thus temporarily easing the difficulty, but finally increasing the disease. He needs to courageously take the opposite course (never rashly, however), and meet the consequences, which are likely to be manifested in some increase of coughing and raising—the very things he needs to do, but which he is apt to shrink from as much as possible. In avoiding natural “expectorants,” the necessity for artificial ones seems to arise. In the one case he raises with some effort what, in his present state, may be described as the normal amount of mucus; in the other, expectoration is easier because there is more to raise. The former is curative; the latter tends to fatality.
Well knowing that sexual indulgence constitutes one of the most fruitful causes of this disease—of decline, in short, however exhibited—I will conclude by saying, that the consumptive should never depart from the rule of strict continence. (See Appetite.) No language can exaggerate the importance of this injunction for a person who is even threatened with decline, if he means to eradicate his disease. The sexual and the nervous systems (including the brain) act and react upon one another, keeping both abnormally alert, and these upon the digestive and assimilative, through the sympathetic, altogether making a quadrangular fight well calculated to impair—to break down, indeed—the strongest constitution; while with the less vigorous (often the most lascivious; or, maybe,
the victim of a libidinous but otherwise considerate companion) the case is hopeless, unless the true remedy is applied. The patient should sleep alone, if possible, not even the husband or wife sharing the bed—a rule which, from every point of view, is of importance to both the patient and the attendant.
Note.—The underlying principle of this work prohibits the idea of a specific and exclusive treatment for this, that, and the other disease mentioned; for these are named simply in order that we may make a beginning toward understanding the term sickness: the entire volume, from preface to finis, is a treatise on the origin of sickness, its prevention and cure. In view of this, we can not leave the consumptive here, while the dyspeptic, the rheumatic, or the douloureux-tic is invited to a consideration of his peculiar symptoms,—for these, in large measure, are mere accidents, since the rheumatic of to-day may be the paralytic of to-morrow, and the dyspeptic of this year the consumptive next, and so on. But all classes, and all who wish to inform themselves as to what makes pain and sickness, and what ends these symptoms, should study carefully the various chapters, omitting none.
CHAPTER IV.
CONSTIPATION.
Temporary non-action of the bowels as excretory organs, is entirely normal under certain conditions, as (1) following diarrhœa or looseness, whether caused by indigestion or physic, (2) throughout the period of a fast, (3) for the mother, several days (varying from 3 to 10), at confinement,[38] and (4) at such other times
as “Nature finds it necessary to muster all the energies of the system for some special purpose, momentarily of paramount importance,” as in alarming sicknesses where, accompanied by lack of appetite, the bowels remain closed for a considerable period of time. In none of these circumstances should there be continued efforts to excite action. In the last-named instance the lower bowel may need a clearing out by free injection at the beginning, and whenever there are fecal matters to remove; but when convalescence is established, the appetite and strength have returned, food is taken and digested, the bowels will act of their own accord. The practice of forestalling nature in this matter by using physic or injections is often the cause of much mischief—it is an impertinent interference in nature’s plans, and is seldom useful. If the sufferer is never fed, except at convalescence and when a natural appetite has returned, and then only with plain, wholesome food,—restricting the quantity to the present capacity for digestion and absorption,—the evacuation of the lower bowel may be awaited without any feeling of anxiety or alarm at its seeming tardiness. Returning strength is the only needed physic.
[38] The very common practice of administering purgatives or injections a few days after confinement is not only unnecessary—it is fraught with mischief and often with disaster. I have known of instances where robust women were kept sick, and dangerously so, in bed for weeks in consequence of the free use of oil administered by the physician (according to his invariable practice) on the third and succeeding days. At her next confinement, one lady who had suffered as above, having lived hygienically during the gestation period, suffered very little pain, was on her feet, washed and dressed her baby, and had a natural movement on the second day. In another case purgation was attempted on the third day and, oil not acting promptly, the total results of profuse injections at intervals for the next three days, was, on the sixth day, to bring away about a teaspoonful of strawberry seeds, the residue of berries eaten on the previous day. It is evident that the food was well digested and absorbed into the circulation, and that no fecal matters were secreted; hence no occasion for the bowels to “move,” in the common understanding of the term. In cases where women approaching confinement are troubled with constipation (entirely unnecessary if they will live properly), the lower bowel should be evacuated by the aid of free injections prior to delivery; but succeeding that event nature may well be left to herself for a time. Nature, however, does not have a fair chance where patients of this class are overfed; hence, and hence only, the necessity for “aiding” her in moving the bowels.
In case of severe constipation, injections—internal baths, so to say—may be employed in emergencies, but infrequently and with extreme care, lest they aggravate the evil and provoke others. Although in no sense as injurious as purgative medicines, which inevitably impair the nutritive organs, still enemas should never be depended on for daily movements.
Next to a correct dietary, with liberal exercise in the open air, one of the best aids in promoting regular action of the bowels is, in my opinion, passive exercise—kneading of the bowels for say five minutes or more before each meal—and the more active exercise of, say, imitating for a few minutes the arms-and-body swinging motions of a mower in the hay-field; spending another few minutes in hopping up and down, twice on each foot alternately, while “keeping time” by slapping the thighs and swaying the body to the right and left; stooping and rising, bending forward and back, etc.; twisting the body around, first one way and then the other, with the hips as the pivotal point (at stool this last greatly facilitates the ejective process), etc., etc. Sedentary persons, and all who feel “chilly” at times, will find, upon trial, that a few minutes devoted to such exercise, occasionally, or whenever the need is felt, will be far more satisfactory than extra garments, or hovering about the fire: it sets the blood a-tingling in the veins and warms a body up.[39] (See Consumption,
for general regimen as to diet, air, exercise, clothing.) If for a time the bowels are willful in the matter of demanding rest to complete a process of healing going on in the diseased glands when there has been distention and irritation, or until a reformed dietary shall have strengthened the general system when, from any cause, it has been under-nourished, and there is, consequently, no action for two, three, or even four days at a time, it need occasion no alarm, and the novice will be surprised to see how natural a movement will finally reward his or her patience in awaiting the call of nature, instead of badgering her into unnatural activity. It must be remembered that it is good health that ensures daily movements, and not daily movements good health. Indeed, when produced by hook or crook, as is often the rule with infants, and adults, even, they do much harm. Daily purgations or injections are made necessary only by gross feeding; and if the latter abuse be persisted in it may be best to move the bowels frequently at all hazards. Under the influence of this combination, however, the small intestines are often so disordered as to impair, even destroy, their power of assimilating food, and together with the colon, or large intestine, become so torpid as almost to require the use of dynamite to move them.
[39] William Cullen Bryant,—a most worthy model, mentally, morally, and physically—thus explains how he had “reached a pretty advanced period of life without the usual infirmities of old age.” Next to his abstemious and mostly vegetable diet, and pure moral life, we may well agree with him in the belief that his wonderful preservation was largely due to his custom of going to bed early and early rising, and “for a full hour, immediately upon rising, with very little encumbrance of clothing, taking a series of exercises, designed to expand the chest, and at the same time call into action all the muscles and articulations of the body,” followed by a bath “from head to foot.”—Hygiene of the Brain: $1.50[C] New York, M. L. Holbrook.
[C] This most valuable work contains letters from a score or more of eminent men and women who have lived to advanced age, descriptive of their living habits. The similarity of their mode of life is a feature worthy of remark.
Straining at stool is, beyond a slight degree, abnormal, or is made necessary only by abnormal conditions, which render defecation difficult; it tends to perpetuate and increase the difficulty, and should not
be practiced ordinarily. The congestion and engorgement of the blood-vessels in the region of the rectum and anus from various causes, as retained fecal matters, or irritation and congestion of the genital organs (which two causes act and react upon each other), produce hemorrhoids (piles), and this complaint is aggravated by the straining referred to. In such cases resort must be had to cool or tepid injections for a time. One effect of deep breathing, from either exercise or habit—filling the lungs in such a manner as to press the diaphragm downward—is to cause regular pressure on the bowels, which aids in exciting their vermicular motion, and facilitates the action, both of the small intestines as digesters, and of the lower bowel in its secretory and excretory functions. The “movement,” when natural, consists of waste matters secreted from the blood by the glands of the colon, and not, as is popularly supposed, of food substances, at least not to any considerable degree. When it does (and I am bound to say that this is the rule, rather than the exception), it is because the person has eaten at least that much more than he ought. A good rule for many who suffer tortures of mind because of constipation would be: mind your own business and let your bowels mind theirs. Strive not to have movements, but rather to deserve them. That is, attend to the general health by living hygienically, and the bowels will, if given regular opportunity, move when there is anything to move for! With infants or young children, a little excess of food will, at first, occasion a little looseness, or increased action, usually;
deficiency in diet would cause constipation. The remedy in either case is plain: a little less food in the one case, a little more in the other. The first symptom, looseness, could not result from deficiency in diet, that is, if the deficiency related to quantity solely—the quality being plain and digestible. Tanner had no movement during his fast; Griscomb’s experience was similar, and Connolly, the consumptive, who fasted forty-three days, had no movement for three weeks, and then the temporary looseness was occasioned by profuse water-drinking, which in his case proved curative. In common life, it is rare indeed that constipation is the result of a deficient diet, although it often arises from lack of nourishment consequent upon excess, or an unwholesome variety of food, or both. Usually it may be regarded as the “reaction” from over-action. The not uncommon experience, in regular order, is this: Excess in diet, diarrhœa, constipation, physic or enema, purgation, worse constipation, more physic, and so on. The term reaction here means simply that the organs involved having been irritated by undigested food, and having by means of increased action cleared away the obstructions, now seek restoration by the most natural method, as the name itself implies—rest. What are commonly called diseases are in reality cures; and the common practice, with drug doctors, of