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.
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 anæmic 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.
"I was struck with the extent to which these evils may go, in the case of Mrs. P., æt. 52, who was brought to me from New Jersey, having been in bed fifteen years. I soon knew that she was free of grave disease, and had stayed in bed at first because there was some lack of power and much pain on rising, and at last because she had the firm belief that she could not walk. After a week's massage I made her get up. I had won her full trust, and she obeyed, or tried to obey me, like a child. But she would faint and grow deadly pale, even if seated a short time. The heart-beats rose from sixty to one hundred and thirty, and grew feeble; the breath came fast, and she had to lie down at once. Her skin was dry, sallow, and bloodless, her muscles flabby; and when, at last, after a fortnight more, I set her on her feet again, she had to endure for a time the most dreadful vertigo and alarming palpitations of the heart, while her feet, in a few minutes of feeble walking, would swell so as to present the most strange appearance. By and by all this went away, and in a month she could walk, sit up, sew, read, and, in a word, live like others. She went home a well-cured woman.