Papers on Health

by John Kirk

Rest.—In every person there is a certain amount only of force which is available for living. Also this force, or vitality, is produced at only a certain definite rate. Where the rate is very low, only perfect quiet in bed for a time can bring down the expenditure far enough to enable the vital force gradually to accumulate, and a cure to be effected. Sitting, in such cases, may be serious overwork.

When rest is ordered, we are often met by the reply that it is impossible, as work cannot be given up. It is, however, often possible to get a great deal more than is taken. Every spare moment should be spent lying down in the most restful position. It is an important element in nursing to give such a comfortable recumbent position to a patient as constitutes perfect rest, and the nurse who does so, does a great deal to cure.

There is with many a prejudice against rest. It is somehow believed that it is a weakening thing to lie still in bed. "You must get up and take exercise, and enjoy the fresh air." This is a very good order for a person who has the strength for bracing exercise and fresh air. But this is absent in a person truly ill. That person's vital force is low, and the organs that supply it are feeble in their action. The fresh air may enter the chest, but the lungs are not in a state to make good use of it. "Exercise and fresh air" only consume the sufferer. On the contrary, rest and fresh air allow the weak vital force to recruit. The sort of exercise which is wanted in such cases is given by others in massaging or such squeezing the muscles as stimulates the organic nerves without using vital force in the sufferer. We have repeatedly succeeded in giving new strength by some weeks in bed, when it could not have been given otherwise. It is all very well for a young, strong person, only a very little out of sorts, to take a cold sitz-bath for ten minutes, and then a walk of a mile or two in mountain or seashore air. But this treatment would be death to one really ill. Perfect rest in bed, with an abundant supply of air through windows open night and day, would save the life which such "exercise and air" would send out of the world. It requires only a little common sense to see this. "He must be weakened by lying in bed so long." There is no such "must" in the nature of things. On the contrary, it may be absolutely necessary to his getting strength that he should lie still for weeks on end. You may, no doubt, give us instances in which a person was compelled to get up, and was thereby made to lose the delusion that he was not able to do so; but such instances in any number will not make one strong who is actually weak. Make sure first that vital energy is supplied, and when that supply rises to a certain degree it will not be easy to keep your patient in bed.

We would also note that true rest can never be had in a forced position. A limb bound down is not resting. The agonising desire to change its position shows this. True rest is found always in freedom and ease. It may be necessary to put splints on a limb, but it must never be done where rest is aimed at. Usually there is a position of comfort to be found. Let the patient find and keep that. He will then have rest.

For instance, an exhausted patient is lying at full length in bed, but under the waist there is a hollow which is bridged over by the back. This part of the back calls for a considerable amount of force to hold it over this hollow, but we get a pillow inserted under the back, the muscles relax, and the patient rests. In packing and fomenting an inflamed knee, for example, it is usually better done in a slightly bent position, which is more restful than a straight one. Employ two or three small pillows to prop it comfortably. And so on, in multitudes of cases, the earnest healer will be guided by the patient's own restful feelings. See also Noise; Veins.

Restlessness.—In slight cases, where the patient simply cannot sleep for tossing about in bed, a cold towel placed along the spine, with a dry one above, will usually relieve, especially if changed and cooled several times as it grows warm. If heat be specially in the head, then that may be cooled in the same manner till peace settles down in the brain.

But we must go on to consider those cases of restlessness in which there is no extra heat in either spine or brain. Tea may have been taken in a rather strong infusion, or so late that its peculiar influence may be the cause of the restlessness. It is necessary to avoid this beverage if such restlessness is to be escaped; still it will generally be found that in cases in which tea has caused serious wakefulness and restless tossing, that there is more than the mere effect of the herb, and that superabundant heat is present also; then the application already pointed out will give relief.

Now take an instance in which it seems to be the mind that causes the tossing rather than the body. Preachers after earnest preaching are in many cases sleepless and restless too; so are almost all persons when currents of exciting thoughts have been set agoing in their minds. Then, no doubt, it is necessary to get at relief from the spiritual side, by means of thought fitted to calm down the excitement that has been raised. But it is never well to forget that in all such cases there is a material as well as a spiritual aspect of the experience. Many preachers take a sitz-bath before going to bed after a day of service, and find that somehow when sitting in the cool water the over-driven brain begins to slacken pace. If from any cause you are restless and cannot lie still, even after the head and spine have been cooled as we have described, it is well to take a sitz-bath in cold water for a few minutes. Dry and wrap up well, and you will be quiet after. Certain forms of coughing apparently cause the most serious restlessness. A warm poultice should be placed between the shoulders, and cold cloths pressed gently on the breast.

If there is extreme shrinking from everything in the least degree cold, then you need to go a step back in your treatment. A sponging of the most gentle kind, with cayenne lotion (see) and water, all over the body, given very carefully for three or four days, once a day, will put away the shrinking to which we refer. This should be done with tepid water at first, but as the skin freshens it will be found comfortable to do it with cool water. In tender cases the poultice or hot bag will need to be comfortably warm, and not hot. The cool cloth must not be wintry cold, nor even at first summer cold. It is, however, necessary to get at the hot and irritating surfaces that are causing the cough, with more or less that is cooling. We may do this ever so gradually, but we must do it, if we would succeed in giving rest from the cough. In a strong person's case there is really no difficulty. It is an easy matter to put on cloth after cloth till the irritated part is reached and cooled. But when the patient is spent to all but a skeleton, and has restlessness from frequent coughing, it is a very different matter. Still to the very last the irritating heat may be kept down, and long sleeps given, when otherwise it would be hard work indeed to get through the last stages of illness. We write thus because we know it is possible to give precious relief even when it is out of the question to save life. It is possible to make even the last night on earth comparatively a peaceful one, instead of its being so very restless as it often is. This is to be done just by cooling the parts that irritate, and these only. Generally, heat may be required rather than cold, but at the part which is irritating and keeping up the coughing, there must be cooling. The kind and capable nurse who can carry out this cooling is beyond all price. Those only can understand this who have been delivered from an all but incessant cough by means that produce no reaction. It is also well to remember that we now and again give life by means of rest when we had no idea of giving more than temporary comfort. We have repeatedly had cases in which there seemed no hope of doing anything further than giving relief, but that relief has turned out to be the commencement of cure.

Rheumatic Fever.—See Fever, Rheumatic.