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uredial therapon of its one
pouring in eaob nostril four to five drops of progress and inquiry. Deroum, in speaking 5% argyrol solution. This will in all prob- of the inauguration of the rest treatment to ability prevent further suppuration. In the apply to the treatment of neurasthenia and cases of children afflicted with adenoids, the bysteria, says: “It is diffioult at this day, fact that they have never breathed through the more than a quarter of a century after Weir pasal passages before, will make it necessary Mitchell's first utterance upon this subjeot that this should be made a practice after the to appreciate the importance and the radical operation. The children should be con. character of this innovation in therapeutics. stantly told to keep tbe mouth closed, and In the treatment of chronio affections, as in if the children do not obey strictly,some sim. that of acute diseases, physicians had been ple contrivance to keep the mouth closed in the babit of relying almost exclusively should be obtained.
upon medicines; and, when other remedies, Breathing exercises, cold sponging of the such as massage and electricity, were em. chest and back, followed by brisk friction, ployed, they were used in an independent games and exercises in the open air are all and isolated manner. They were not incor. further aids to the establishment of the nor- porated as parts of any one method or plan mal respiratory modus.
of treatment, and, as regards rest, it is safe to The breathing may also be aided by insist. say that up to the time of Mitohell, no one ing upon slow, thorough and prolonged mas. had bad any adequate conception of its im. tication, as during this act respiration be. portance or of its great therapeutio power. comes automatically nasal. Out of this rea. No one bad ventured to employ it in so radi. son Friedenburg considers the otherwise aw- cal a manner nor in a way involving weeks ful habit of gum ohewing for children, to be and months of continuous stay in bed. The used temporarily after operation, as a valua. ill effects of excessive rest, of insuffioient exble aid in re-establishing nasal respiration. ercise, had been vaguely recognized, but no
one bad attempted to combat the disadvan. tages of rest, to robit of its barm by the ap.
plication of corrective procedures; no one THE USE AND ABUSE OF THE REST had attempted to formulate a plan of treatTREATMENT.*
ment in which rest should be the main thera
peutic measure, rest so guarded and corFRANK PARSONS NORBURY, A.M., M.D. reoted that none of its evils, only its benefits
should accrue to the patient. It is in this JACKSONVILLE, ILL.
achievement which belongs to Weir Mitchell, Professor of Nervous and Mental Diseases, Keokuk Medi
an acbievement wbich is distinotly and solely cal College, College of Physicians and Surgeons ;
bis. The rest cure is essentially a oure by Our Savior's Hospital.
physiologic methods and this alone is suffi. It is needless for me to come before you
cient to give it the stamp of originality.” with a defense of the Rest Treatment, for any
Now, what is meant by the rest treatment?
It is a treatment founded upon the principles treatment which for nearly thirty years has of rest with such adiuvants as will contribute maintained the place in rational therapeutics,
to keep simultaneously and methodically both which it ooou pies, is its own defense. The
physical and mental factors in view, so that rest treatment has been adopted in all coun.
in restoring "fat and blood,” under appro. tries where progressive medicine claims at.
priate envirnoment, the will-loss, moral delin. tention and receives the homage due it. It
quenoy and perverted emotional states, will was evolved by S. Weir Mitchell, of Phila
be overcome. The foregoing implies that the delpbia, the Nestor of American Neurology,
range of treatment is perhaps limited to the whose genius prompted bim to the original
neurasthenic and hysterical classes of cases. and painstaking observations, from which
This in part is true, but I have found it ap. was originated the rest treatment with its
plicable to a wider range of cases of mental technique, now so universally adopted and
disease; so much, in fact, that I have for the practiced throughout the civilized world.
past four years used it extensively in this line Those of you interested in the history of
of practice. This mode of treatment has medicine and especially of events which mark
proven remarkably efficient in borderline an epooh in the practice of medicine, will
mental cases, especially the mental disorders find in Dr. Mitobell's recital of the evolution
of adolesence; in serious and seen ingly invet. of this treatment, a source of interest and of
erate senile forms of mental disorder; in enthusiasm, such as comes to us all when we
manic-depressive cases of mental disease; read of historical triumphs in other fields of
in melancholia, simple and mixed forms; in *Read before the Tri-State Medical Society (Alabama, subacute states of delirium (amentia); in
exhaustion psychoses and in habit cases.
Medical Superintendent, Maplewood
Sanatorium: Neurologist to
Georgia and Tennessee) at Chattanooga, Tenn., September %, 1905
However, the rest treatment is best known life (the patient's life) of sickness, and you As associated with the class of cases for wbich will bave made a change which will in it. it was primarily designed, riz: the neuras. self be beneficial and will enormously aid in thenia of women in which the mental as the treatment which is to follow.” This ap. thenia and the denutrition of the body that plies to that class of women, "a large and follows on insufficiency in the amount of troublesome class of thin blooded emotional food taken; these lend one another mutual women for wbom a state of weak health has support and combine in keeping up indefin- become a long and almost, I might say, a itely the nervous exbaustion. Mitchell's cherished habit.” For them there is often originality in the rest treatment, to wbiob be no success possible until we have broken up modestly claims, lies in the systematio asso. the whole daily drama of the sickroom, ciation of isolation, rest, massage, eleotricity with its selfishness and its craving for symand special regulation of diet or diotherapy. pathy and indulgence." Nor should we hesThe success or failure of the treatment de- itate to insist upon this change, or not only pends upon how rigidly these essentials are shall we then act in the true interests of the emphasized and insisted upon. Again, the patient, but we shall also confer on those seluction of cases suitable for such treatment near to ber an inestimable benefit.” requires careful consideration and an accu. How true these remarks are can only be mulated experience in nervous diseases. appreciated by physicians who have had to Mitohell, himself says, regarding this last face such a problem and bave attempted to point, 'It runs, indeed, the risk of being em. care for such a case at bome. I see in conployed in cases which do not need it and by sultation muny of these sad pictures and persons who are not competent, and of being many of them have come under my care after thus brought into disrepute.” To bring before exhausting every conceivable tentative measyou the technique of treatmert, I want to ure that would put off that inevitable day briefly touch upon the essential elements of when the patient's friends exbausted in treatment and the reusons for their adoption. strength, resolution, and depleted in purse, Of the first importance in successfully man have come to the realization that not only aging a case wherein rest treatment is indi. must systematic and intelligent care be bad cated, it is necessary that the patient be iso. for physical reasons, but moral decrepitude lated from the environment in which she which is paramount must be met by forci. bas generated the nervous exhaustion and ble means. Isolation is the only way to where conditions even at best cannot be meet that difficulty, but it must be secured made suitable for proper rest treatment. under bopeful, helpful and intelligent sur. Isolation or seclusion, as Mitobell calls it, roundings where nurses trained to meet the must be complete. Comparative isolation is exigencies of such cases can, under the pbynot worth the time or money spent to keep it sioian's directions, lead these apparent up and only brings trouble upon all con- hopeless invalids back to life of usefulness. cerned in its execution and ends in the con. The nurses function, then, is of a high order demnation of the "rest treatment.” My rule and requires character, good sense, intelliis imperative, isolation, and in explaining to gence and taot, as prerequisites for success the patient's friends, 1 liken the isolation to from the nurse's standpoint. The possession a splint, which when once applied correctly of a diploma does not make a nurse for neris not to be removed daily to see how things vous and mental ouses, for, in my judgment, are doing. No! isolation is necessary, and I it requires the highest order of intelligence to quote the reason for it as explained by Mitch. sucoessfully handle a patient, condemned, as ell— "It is needful to disentangle them the patients olaim, for six weeks or months or (the patients) from the meshes of old habits more isolation from the world with no one and to remove them from contact with those but the nurses and physicians as mediums who have been the willing slaves of their to the outside world. No other visitors are caprices. I have often made the effort to allowed. Upon the physician rests the cul. treat them where they have lived and to iso tivation of will power, the sub-conscious self late them there, but I have rarely done so by hopeful and intelligent helpful sugges. without promising myself that I would not tions and by actual demonstration at their again complicate my treatment by such em. side, the improvement and gain of their barrassments." This has been my unfortun. health of mind and body. The length of ate experience and I now prefer to retire time isolation is to continue depends on from a case, than, in a bapbazard way, at the progress of the case, an average, I tempt to carry out rest treatment at home. should say, of from six weeks to three or Dr. Mitchell further says, “Once separate the four months or more. My records of about patient from the moral and physical sur. four hundred cases will show an average roundings which have become part of her stay of isolation of about two months, but some have remained as long as a year, some as if she were the viotim of typhoid fever. six months some four months and some six This rest gives the body an opportunity to weeks. Men do not endure isolation as well re-establish normal funotions; it rests the as women; first, because domestic life is mind, the sense, the muscles, and sootbes all uot their natural habit; and second, because pains and other disturbances. With regulated it is diffioult to seolude them, they will diet, the very varied stomach and intestinal break over the rules when convalescence is disturbances disappear, but in order to ac. being established.
complish this and to overcome the disadvan.
tages of inactivity, the gastro-intestinal Rest.—The second and next importance to atony, constipation and general regulation of isolation in the success of treatment is rest. the muscles and to insure the digestion and Now rest, as I understand it and as taught by assimilation of food, there must be some Weir Mitchell, is not simply reclining on a means to aid in overcoming these serious dissofa, por sitting in an easy chair, nor simply advantages of rest. Disadvantages, too, upon staying in bed. This must be understood if which binge the failure of the treatment; diswe are to succeed in this part of the treat. advantages whioh too many physicians recog. ment; all the time remembering that success nize, but go no further in their endeavor to as a whole in rest treatment depends upon overoome them. It was here where Mitchell's how intelligently each detail of treatment is originality showed forth with the genius of carried out. Mitchell in speaking of the a true scientist and observer, wben, recogniz. rost says: “Whether we shall ask a patient ing these conditions he sought relief in the to walk or to take rest is a question which application of massage. turns up for answer almost every day in prao. tice." "Most often we incline to insist on Massage.—Massage, too, we must remem. exeroise and are led to do so from a belief ber, which he evolved to meet the special that many people walk too little and that to indications as found in these cases of neuras. move about a good deal is well for every. thenia, bysteria and mild mental diseases. body.” Mitohell thinks that we are as often The chief indication was to deprive rest of wrong as right. A good brisk walk is for its evils." For, in the intelligent applicawell folks a tonic; the same is true for some tion of rest, it is found that its usefulness sick folks, but if exertion gives rise to in. depends upon the care and attention given crease of trouble, to extreme sense of fatigue, to massage and eleotricity. Massage is a to nausea, headaobe, eto., wbat are we to do? muob misunderstood physiologio tberapeutio For these cases, rest, absolute rest, is neces- measure, even today. There are compara. sary. Bardly a day goes by but that I meet tively few trained in massage according to in my consnlting room or in consultation the methods as evolved by Mitchell, and what with physicians, cases of abnormal fatigue. passes for massage as given by many nurses,
Cases where crdinary physiological rest is not satisfactory in nervous and mental does not relieve them from the very apparent cases. I wish that time would permit me exhaustion. It is evident that to advise ex. to go over every detail of massage manipu. eroise, as is too frequently done, will only add lations, according to Mitobell's teaching. I fuel to the flame, and to meet intelligently would say it requires skill to administer mass. these problems we must recognize or differ. age, and it requires daily practice to attain entiate normal from abnormal fatigue. The the perfeotion of the art. The teobnique of one is overcome by physiologic rest, the Mitobell has a definite purpose in every other is continuous, as the patient is as tired novement and is free from the over-zealous in the mornings, after rest in bed, as they activity found in Swedish movements or the were on retiring, and so goes the interminable crude manipulations of osteopathy. It is to story until the whole problem is realized by be romarked that such movements have no the physician and proper means applied to place in the treatment of nervous people; restore normal funotions.
they inorease excitement, produce exhaustion Rest as a therapeutic measure is to be pre instead of ameliorating the conditions. Massscribed with consideration of the indications age is to be given by trained graduates in in each case. Rest is a relative term and has the principles and practices of the art. Why a wide range of application. Rest, as ap massage does good is explained by Mitobel] plied to nervous and mental cases, properly as follows: "The secretions of the skin are selected, means absolute rest in bed. It stimulated by the treatment of that tissue; means, first, a state of total inactivity; tbe ... under massage the fabby muscles aopatient is fed, bathed and cared for in bed. quire a certain firmness, wbioh at first lasts All activity is suspended; no ocoupation, nor only a few minutes, but which after a time reading, no writing; she must not get up nor is more enduring and ends by becoming pereven use her hands; in fact, she is treated manent. . . The muscles are exercised
without the aid of volitional exertion or the in the wilderness telling of his discovery of aid of nervous centers, . . . a healthful means and methods which are to supersede exoitation of the vessels and inoreased flow of the Mitchell rest treatment-by occupation, blood to the tissues which they feed... by education, by exercises, by baths, etc., The visible results as regards the surface cir. eto., but like all fads they have a mushroom culation are sufficiently obvious, and most existence whioh soon tells the tale, while the remarkably so in persons who, besides being time-tried methods of Mitohell, like Tenny. anemio and thin, have been long unused to son's brook, go on, and, we trust, forever. exercise." In my own hospital, wtere about two hundred and fifty cases have been under Diotherapy. I have not mentioned treatment, I have seen adolescent girls ane another and exceedingly important part of mic, depressed, hysterical and even insane, treatment, which, as regards the building up react under massage, rest and isolation to a of bodily weight and founding permanent degree that is really remarkable. The whole capital in fat and blood, is always an importtint of the body changes, a warm healthy ant consideration-I refer to diet. Diother. glow, full vessels, pink nails, pink cheeks and apy is one of the factors in the treatment of a wholsome comfort and physical gain re- nervous and mental diseases little appreciated sults. Bodily weight increases and a new in practice outside of special practice. Exlease on life certainly is the result. The oir. perience and prudence, tact and judgment are culation of the blood is improved both super- required to successfully carry out the indica. ficial and deep, anemio conditions disappear tions for diotherapy. It is important first to and the wholesome benefits which results are ascertain the needs of the patient, especially lasting. Massage genuinely given by genu.. where gastro-intestinal neuroses are features ine manipulators who know their business, of the disease. To differentiate by careful from prinoiples and practice, is one of the clinical methods the nature of the neurosis most valuable adjuvants of treatment of ner- and to plan treatment accordingly. Not in. vous diseases of malnutrition. Its value is frequently it becomes necessary to make a not appreciated, and every physician should prolonged examination in order to differenhave at his command this valued service. tiate between organic and functional disease. Mitchell says that bad massage even is bet. Here is where prudence is necessary and exter than none in these cases in which it is perience important for other therapeutio in. needed.
dications that diet must be considered. I
think that we should take plenty of time in Electricity. -- Faradism applied to the working out these problems of gastro-intesmasses of musoles is another adjuvant used tinal neuroses. to exercise muscles in a passive way. It is Now, as regards diet, I follow Mitchell's not used as often as it should be and when precepts wherever they are indicated. Milk given should be under the direction of one diet is the sheet anchor in almost every case, properly trained to administer it. Electric and rare indeed is the case where milk can ity, unfortunately, in the layman's view, is not be used, if the patient is approached with a mysterious agent, capable of curing most tact and consideration. Where milk is the anything of obscure origin, especially along exclusive diet, four to five pints a day are used the lines of nervous disorders. It requires a and given from four to six or eight ounces at clever operator, trained in the work, to give a time—the schedule for giving to be deterelectricity properly and to know when it is mined in each case. Milk is progressively indicated. Its object is to stimulate the ao increased and other foods added, ogg.nog, tivity and nutrition of the muscles and joints, toast, bread and butter, etc., gradually addimprove general nutrition, stimulate the lym. ing until a full tray as well as the milk conphatic system, digestive organs and improve stitutes the daily diet. To assist in digestion, circulation. In the proper blending of these assimilation, etc., it is necessary that the senecessary and important adjuvants of treat- oretions be in good form, and sometimes aids ment by rest methods, experience will lead to are necessary. Malt extract is given alone, skill in determination of the degree and di. and when constipation is a factor, with cas. reotion of the treatments, of the character oara, with the object of aiding digestion and and form of rest and the adjustment of en- impairing the bowel condition. It is to be vironment to meet the indications during noted that with the aid of massage that asoonvalescence. This experience can not be similation is improved and cases accept and detailed on paper very well; and yet it is just tolerate food in greater quantities than withhere where abuses occur and results are not out this valued aid. Bodily weight is in. attained, all of which leads to a condemna. creased, new form is given to the anemio, tion of the rest treatment. Every now and emaciated, wasted patient, and life becomes then some one feels he is called upon to cry worth while to these afflicted ones. Patience, preseverance and judgment, under wholesome to the limit. I know, and in this statement environment, are required to carry to success. I am sustained by Mitchell, Playfair, Allbutt ful issue this treatment by rest methods. and other authorities, that in properly se. The abuse comes in not appreciating the lected cases, a oure may be expected, especially value of each factor; in leaving out one or in women, a cure that will remain a cure as the other; in lax methods of isolation; in long as proper mental and nervous hygiene absence of taot in securing the confidence of is maintained. Allbutt especially dwells the patient; in the failure to appreciate the upon its efficacy in cerebro-spinal, cardiac time required to accomplish results; in the and gastrio forms in ill-nourished subjects absence of the proper environment and of the and with comparative certainty and perma. real and essential factor; an educated, taot. nenoy of its results. ful, resourceful, wholesome, genuine good Again, another class which I believe is a nurse. Then, too, last but not least, the growing olass with the advance of abdominal : hopefulness which the physician can inspire; surgery, and that is the post-operative neu. the patience he can cultivate and the tran- rasthenio olass. It has fallen to my lot to quility be oan inculcate are all useful factors see within the past few months six oases, all in treatment.
of whom have had abdominal section for one Now as to the uses of rest treatment, the reason or another, and all of whom have de. selection of cases and carrying out of details. veloped neurasthenia or more pronounced First, and above all, it is to be remembered mental disease. Surgeons should study the that if success is to follow that there are sev. needs of their patients from this standpoint eral things to be impressed upon the patient and enforce rest treatment to its fullest in and her friends—of these, consent to absolute the cases wherein neurasthenio symptoms control of the patient during continuance of are pronounced. I really believe that rest in the treatment, and that she is to be removed such cases bas as much to do with the bril. from home, away from the environment, too liancy of recoveries in some cases as the oper. frequently vicious, and that isolation to the ative interference. point of seclusion is to be followed without The time spent in bed under appropriate à quibble from the parents or friends of the environment and regulated hygiene has been patient. I have learned this lesson by bitter a very potent influence in many cases of the experience, and it is the failure of this one surgical diseases of women. As my own important factor that all other adjuvants experience acoumulates, and I have treated failed, partially or wholly. In young girls, over four hundred cases by rest treatment, I neurotio, hysterioal, with or without imagined am more and more convinced of its value. pelvio, digestive, heart or other disorders, it To insure success, however, we must organis absolutely necessary that isolation be en- ize for it and be just as careful in our techforced. What is worth doing is worth doing nique as is the surgeon in bis modern organwell, and along this line let me quote you ization and technique in his work, Eaob Clifford Allbutt. He says: "The three legs factor is to be considered and none left out, of the tripod are isolation, full feeding and for it is the treatment as a whole which acmassage, without all three legs the tripod can complishes results. The factors, then, are not stand." Yet, one patient is submitted to isolation, rest, massage, electricity, diet, an massage without isolation; or, to another educated, tactful nurse, a hopeful, helpful, massage is applied without rest, which is a optimistic physician and a suitable, wholecondition of its use, for even a healthy per. some, restful environment. son would find it hard to undergo daily massage and concurrently therewith to go about his ordinary work... Again, the
VACCINATION FOR FILIPINOS. - $100,000 feeding has to be caloulated on a special
has been appropriated by the Philippine scale, having regard, of course, tu each case;
for conducting vaccination this caloulation calls for skill on the part throughout the islands. of nurse and physician. .. No case of NEw MEDICAL COLLEGE.- Pekin, China, any severity can be cared for in the midst
has recently bad formally opened the Union of the fuss and fidgets of the home.”
Medical College. The Protestant missions My own experience is that in young are responsible for its establishment. women with indulgent parents, one or both of whom are neurotic themselves, overly anx. MORE LEGISLATION.—A bill has been in. ious, overly indulgent and overly critical of troduced in the New York legislature fobid. physician and nurse, supply an atmosphere ding the marriage of insane, epileptic, imbe. in which a most beautiful and chronic case cile or feeble-minded persons. It also makes of hysteria can flourish and a continuous it a felony for a healthy person to intermarry neurasthenia, with its perennial story, go on or live with such an individual.