The "Rest Cure"

At the commencement of treatment in severe cases the patient must lie absolutely quiet in bed and not be even allowed to raise the arms or head to take food. After a week or ten days of such enforced and absolute rest, the patient may gradually be allowed to sit up and feed herself, but usually a full month or six weeks should be spent in bed with no further exertion. The lack of voluntary exercise must be supplied by the tonic effect of bathing and massage. The patient should receive a sponge bath every morning soon after breakfast, which is to be given with hot water, or hot sea water if it can be obtained. A portion of the body only is to be sponged at a time, and friction with a coarse towel should immediately follow. In some cases benefit results from rubbing a piece of ice or a cloth dipped in ice water over the skin for a moment after the hot-water sponging. The alternate stimulation of the cutaneous nerves by strong degrees of heat and cold always produces a tonic effect, and the influence of the ice water and friction is analogous to that produced by the Brand system of cold bathing.

After the bath, which, if properly given, may consume a half or three quarters of an hour, the patient must be allowed to rest, and at noon or in the early afternoon massage is to be given, at first every day, and later on alternate days. At the commencement of the case the massage should be exceedingly mild, and caution is required in this respect, for neurasthenic patients are often injured by the too vigorous or prolonged efforts of the massage operators. For the first day ten or fifteen minutes will suffice, and if the effect is favourable, the time may be gradually extended to an hour. Owing to the nature of the diet, which at first is of milk, and from the lack of exercise and loss of tone of the intestinal walls, neurasthenic subjects are uniformly constipated, and the massage should be particularly adapted to remedy this difficulty.

Massage of the abdominal muscles should be performed by gently rubbing and kneading the abdomen, commencing in the right iliac fossa and following the direction of the colon upward to the free border of the ribs across to the opposite side and downward to the sigmoid flexure. By this means peristaltic action is undoubtedly stimulated, and the contents of the large intestine are mechanically propelled in the proper direction.