If massage is not ordered, there is nothing in this routine which costs money, and I have found it apply usefully in the case of hospital and dispensary patients.

In carrying out my general plan of treatment in extreme cases 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, or to use the hands in any active way except to clean the teeth.  Where at first the most absolute rest is desirable, as in cases of heart-disease, or where there is a floating kidney, I arrange to have the bowels and water passed while lying down, and the patient is lifted on to a lounge for an hour in the morning and again at bedtime, and then lifted back again into the newly-made bed.  In most 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 order 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.

The daily sponging bath is to be given by the nurse, and should be rapidly and skilfully done.  It may follow the first food of the day, the early milk, or cocoa, or coffee, or, if preferred, may be used before noon, or at bedtime, which is found in some cases to be best and to promote sleep.

For some reason, the act of bathing, or even the being bathed, is mysteriously fatiguing to certain invalids, and if so I have the general sponging done for a time but thrice a week.

Most of these patients suffer from use of the eyes, and this makes it needful to prohibit reading and writing, and to have all correspondence carried on through the nurse.  But many neurasthenic people also suffer from being read to, or, in other words, from any prolonged effort at attention.  In these cases it will be found that if the nurse will read the morning paper, and as she does so relate such news as may be of interest, the patient will bear it very well, and will by degrees come to endure the hearing of such reading as is already more or less familiar.

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.