Common Remedies: Bed rest

CONFINING a sick person to bed is a central feature of traditional medical care - but one that has been gradually abandoned over the past 30 years. In the Sixties someone in hospital after a heart attack would be kept in bed for as long as six weeks. For the first week or so complete rest was strictly enforced: the wretched patient was not even allowed to wash himself. Women who had given birth naturally to healthy babies were kept in hospital for 10 days, most of it in bed. Children were treated with the same conviction that bed rest was life-saving; those with rheumatic fever might be in bed for months. Children were kept in bed even for minor infections such as chicken pox - they were not allowed up until their temperatures had returned to normal. Rest in bed was also still the mainstay of treatment for tuberculosis.

These restrictions did have a reasonable basis. Observation had shown that injuries heal faster if the injured part is rested. The key to the treatment of fractures is that the broken bone is immobilised in a plaster cast; injured muscles and cuts in the skin heal faster and with less scarring if the arm or leg is kept still. Surely, doctors reasoned, a heart damaged by a coronary thrombosis, a lung damaged by tuberculosis, and the uterus after childbirth will heal faster and with less scarring if the whole body is put to rest.

So why has bed rest gone out of fashion? The answer is simple: it is too dangerous, especially for the sick. After an operation and during sickness, the blood clots more easily. Keeping someone in bed slows the circulation, and the blood stagnates in the veins deep inside the legs and pelvis. Blood clots form in these deep veins, and fragments may then be carried into the heart and lungs, where they become trapped - a pulmonary embolism. A big one may stop the heart. As many as a third of hospital patients examined after death have had a recent pulmonary embolism, and it is the main cause of death in many of these. In the days of prolonged bed rest, pulmonary embolism caused the deaths each year of thousands of patients recovering from minor operations and minor heart attacks - as well as healthy women recovering from childbirth.

Rest in bed, if prolonged beyond a week or so, leads to wasting of the muscles and thinning of the bones. It lowers morale and causes insomnia and constipation. And yet the underlying rationale - that it promotes healing - remains true. But rest can be nearly as complete while the patient is encouraged to walk around, keeping the blood gently circulating and the muscles in use. So the trend has been to get patients out of bed as soon as possible - and the optimum length of stay has been determined by comparing large numbers of patients treated by various periods of bed rest in hospital. Surgeons have experimented to find which operations can be done on an outpatient basis and how soon inpatients may be sent home.

These studies have led to very substantial shortenings in the average time people stay in hospital. The 'improvements in productivity' have a sound medical basis as well as cheering up administrators and politicians. What has gone is the tradition of invalidism that encouraged many young people with chronic illness to educate themselves by spending months lying in bed reading.