Silas Weir Mitchell (1829-1914)
on his Rest Cure.
(Note: Silas Weir Mitchell was an American physician who became famous for his
treatment of nervous disorders. Fat and Blood, 1877, describes his rest cure.
He also wrote historical romances.)
[...] In carrying out my general plan of treatment it is my habit to ask the
patient to remain in bed from six weeks to two months. At first, and in some
cases for four or five weeks, I do not permit the patient to sit up or to sew
or write or read. The only action allowed is that needed to clean the teeth.
In some instances I have not permitted the patient to turn over without aid,
and this I have done because sometimes I think no motion desirable, and because
sometimes the moral influence of absolute repose is of use. In such cases I
arrange to have the bowels and water passed while lying down, and the patient
is lifted on to a lounge at bedtime and sponged, and then lifted back again
into the newly-made bed. In all cases of weakness, treated by rest, I insist
on the patient being fed by the nurse, and, when well enough to sit up in bed,
I insist that the meats shall be cut up, so as to make it easier for the patient
to feed herself.
In many cases I allow the patient to sit up in order to obey the calls of nature, but I am always careful to have the bowels kept reasonably free from costiveness, knowing well how such a state and the efforts it gives rise to enfeeble a sick person.
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 anaemic 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 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.
(originally posted at http://www-unix.oit.umass.edu/~clit121/weirmit.html)