When Bed Is Bad

A doctor should think twice before prescribing absolute quiet in bed--it may kill his patient. This astonishing thesis was the subject of a Cornell Medical College conference on therapy, reported last week in the New York State Journal of Medicine. Said outspoken Dr. William Dock, Cornell pathology professor, leading off the discussion: "Absolute bed rest kills more patients than anesthesia and all the drugs in the pharmacopoeia added together." Yet doctors prescribe it and medical texts give no warning of its dangers.

The trouble with bed rest, observed the Cornell savants, is that man was not constructed to lie on his back. The position: 1) impedes blood flow, 2) hampers digestion, 3) causes compression of the back part of the lungs, 4) robs bones of chalk, 5) weakens muscles, 6) lowers morale (because of bedpans, etc.). The arguments for bed rest are that it cuts down energy consumption and promotes healing. But contrary to common belief, declared Dr. Dock, sitting up in a chair takes little (if any) more energy than lying down. Robbing bones of chalk is no way to heal fractures. Doctors should learn to repair operation wounds so that a little motion will not burst them open.

"Illogical As Bleedings." Most bedrest deaths are caused by big, migrating blood clots which form in veins constricted by the unnatural position. "In the last 300 autopsies on adults in [New York Hospital]," reported Dr. Dock, "15, or 5%, died of pulmonary embolism second ary to thrombi in the legs or pelvis." A little moving around, he asserted, could have saved these people.

"Almost as illogical as the bleedings and purgings of previous generations," continued the pathologist, is the custom of making all victims of heart attacks stay in bed for six weeks. Very often a doctor finds a patient with failure of the left side of the heart sitting up in a chair and orders him to bed, "whereupon the patient proceeds to suffocate." Another lethal effect of bed rest : pneumonia caused by collection of fluid in the lungs. This is why sick oldsters should not stay in bed "one hour longer than necessary." They should sit up part of the time and let such fluid run down toward their feet and ankles.

Not so dangerous are eleven other bedrest disorders mentioned at the meeting, e.g., kidney stones, habitual constipation, prostate trouble, bed sores, muscle spasm. The only patients for whom the assembled doctors thought that absolute bed rest might be allowable were: 1) the victims of a few such diseases as pulmonary tuberculosis, and 2) children, to whom it does little harm.

The Army Is Right. Dr. Dock urged a return to the nursing customs of Florence Nightingale's day when all but prostrated patients got up for meals, bathroom going, etc. There is evidence that bedrest deaths have gone up since nursing became so expert that a patient never needs to move. He had many good words to say for the Army's convalescent program (TIME, Nov. 15), which makes men move uninjured parts of their bodies as soon as they can, and normally gets head injuries out of bed in a matter of days.

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