“I was struck with the extent to which these evils may go, in the case of Mrs. P., aet. 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.

“Let us think, then, when we put a person in bed, that we are lessening the heart-beats some twenty a minute, nearly a third; that we are causing the tardy blood to linger in the by-ways of the blood-round, for it has its by-ways; that rest in bed binds the bowels, and tends to destroy the desire to eat; and that muscles at rest too long get to be unhealthy and shrunken in substance.  Bear these ills in mind, and be ready to meet them, and we shall have answered the hard question of how to help by rest without hurt to the patient.”

When I first made use of this treatment I allowed my patients to get up too suddenly, and in some cases I thus brought on relapses and a return of the feeling of painful fatigue.  I also saw in some of these cases what I still see at times under like circumstances,—­a rapid loss of flesh.

I now begin by permitting the patient to sit up in bed, then to feed herself, and next to sit up out of bed a few minutes at bedtime.  In a week, she is desired to sit up fifteen minutes twice a day, and this is gradually increased until, at the end of six to twelve weeks, she rests on the bed only three to five hours daily.  Even after she moves about and goes out, I insist for two months on absolute repose at least two or three hours daily, and this must be understood to mean seclusion as well as bodily quiet, free from the intrusion of household cares, visitors, or any form of emotion or excitement, pleasureable or otherwise.  In cases of long-standing it may be desirable to continue this period of isolation and to order as well an hour’s lying down after each meal for many months, in some such methodical way as is suggested in the schedule on page 64.

The use of a hammock is found by some people to be a very agreeable change from the bed during a part of the day.