Not that long ago bed rest seemed the answer to most ills. The standard period following a heart attack was four weeks, with three weeks prescribed after hernia surgery and two weeks the norm after having a baby.
From the 1860s to the 1950s, the use of bed rest for recuperation became increasingly popular. Beliefs about its value began to shift in the mid-1940s. Soldiers in the second World War, forced to get up and about quickly because of a lack of bed space, recovered more quickly from their injuries and infections than would have been expected.
One of the more notorious uses of bed rest as a “cure” was as a 19th-century treatment for a number of mental health conditions. At the same time, patients were isolated from family contact; the only person they were allowed to see was the nurse who massaged and bathed them. They were also encouraged to avoid other activities that could exhaust them such as writing or drawing.
The bed rest cure was sexist. Almost always prescribed for women by its creator Dr Silas Weir Mitchell, an American neurologist, it became a popular treatment for hysteria, a disease "de jour".
Believed to be an exclusively female psychological illness with its origins in the womb, hysteria got its name from the Greek word root hyster, meaning womb.
Hysteria
In the late 1800s, Mitchell observed that most women he treated for hysteria were thin and anaemic looking. So he prescribed strict bed rest for at least six weeks, as outlined in his curiously titled book
Fat and Blood
.
“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.”
Initially made to drink gallons of milk, the patient was then encouraged to eat substantially, with the aim of gaining about 50 pounds in weight. Clearly Mitchell wasn’t collecting patient feedback, as he blithely writes that “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, some women were driven insane by the cure and, given what we now know about the physiology of bed rest, not surprisingly some patients died.
Muscles quickly atrophied and bedridden patients were prone to dehydration. Pressure injuries can develop in days. The heart deconditions progressively with a pooling of blood, so when a bed rest patient rises, they faint due to a postural drop in blood pressure. And the permanently recumbent patient experiences reduced lung function, with an increased susceptibility to respiratory infection.
But by far the most dangerous effect of prolonged bed rest is a combination of blood pooling and blood vessel damage which, together with increased blood coagulability, predisposes bedridden patients to deep vein thrombosis (DVT). From this blockage, pieces of clot travel from the leg to the lungs leading to potentially fatal pulmonary embolism.
No evidence
The one area of medicine where bed rest is still recommended is obstetrics. If you have pre eclampsia (pregnancy-induced high blood pressure) or vaginal bleeding due to a low lying placenta, you may be advised to rest until the pregnancy reaches a point where a Caesarean section can be carried out. Although it is still widely recommended, in fact there is no convincing evidence that bed rest prevents pregnancy complications or premature labour.
Nowadays, for most conditions, a doctor is far more likely to tell you to “take up thy bed and walk”.
mhouston@irishtimes.com @muirishouston