Chapter 4. Seclusion

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_ CHAPTER IV. SECLUSION

It is rare to find any of the class of patients I have described so free from the influence of their habitual surroundings as to make it easy to treat them in their own homes. It is needful to disentangle them from the meshes of old habits and to remove them from contact with those who have been the willing slaves of their caprices. I have often made the effort to treat them where they have lived and to isolate them there, but I have rarely done so without promising myself that I would not again complicate my treatment by any such embarrassments. Once separate the patient from the moral and physical surroundings which have become part of her life of sickness, and you will have made a change which will be in itself beneficial and will enormously aid in the treatment which is to follow. Of course this step is not essential in such cases as are merely anaemic, feeble, and thin, owing to distinct causes, like the exhaustion of overwork, blood-losses, dyspepsia, low fevers, or nursing. There are but too many women who have broken down under such causes and failed to climb again to the level of health, despite all that could be done for them; and when such persons are free from emotional excitement or hysterical complications there is no reason why the seclusion needful to secure them repose of mind should not be pleasantly modified in accordance with the dictates of common sense. Very often a little experimentation as to what they will profitably bear in the way of visits and the like will inform us, as their treatment progresses, how far such indulgence is of use or free from hurtful influences. Cases of extreme neurasthenia in men accompanied with nutritive failures require as to this matter cautious handling, because, for some reason, the ennui of rest and seclusion is far better borne by women than by the other sex.

Even in cases whose moral aspects do not at once suggest an imperative need for seclusion it is well to remember, as regards neurasthenic people, that the treatment involves for a time daily visits of some length from the masseur, the doctor, and possibly an electrician, and that to add to these even a single friendly visitor is often too much to be readily borne; but I am now speaking chiefly of the large and troublesome class of thin-blooded emotional women, for whom a state of weak health has become a long and, almost I might say, a cherished habit. For them there is often no success possible until we have broken up the whole daily drama of the sick-room, with its little selfishness and its craving for sympathy and indulgence. Nor should we hesitate to insist upon this change, for not only shall we then act in the true interests of the patient, but we shall also confer on those near to her an inestimable benefit. An hysterical girl is, as Wendell Holmes has said in his decisive phrase, a vampire who sucks the blood of the healthy people about her; and I may add that pretty surely where there is one hysterical girl there will be soon or late two sick women. If circumstances oblige us to treat such a person in her own home, let us at least change her room, and also have it well understood how far we are to control her surroundings and to govern as to visitors and the company of her own family. Do as we may, we shall always lessen thus our chances of success, but we shall certainly not altogether destroy them.

I should add here a few words of caution as to the time of year best fitted for treatment. In the summer seclusion is often undesirable when the patient is well enough to gain help by change of air; moreover, at this season massage is less agreeable than in winter, and, as a rule, I find it harder to feed and to fatten persons at rest during our summer heats. That this rule is not without exception has been shown by Drs. Goodell and Sinkler, both of whom have attained some remarkable successes in midsummer.

One of the questions of most importance in the carrying out of this treatment is the choice of a nurse. Just as it is desirable to change the home of the patient, her diet, her atmosphere, so also is it well, for the mere alterative value of such change, to surround her with strangers and to put aside any nurse with whom she may have grown familiar. As I have sometimes succeeded in treating invalids in their own homes, so have I occasionally been able to carry through cases nursed by a mother, or sister, or friend of exceptional firmness; but to attempt this is to be heavily handicapped, and the position should never be accepted if it be possible to make other arrangements. Any firm, intelligent woman of tact, a stranger to the patient, is better than the old style of nurse, now, happily, disappearing. The nurse for these cases ought to be a young, active, quick-witted woman, capable of firmly but gently controlling her patient. She ought to be intelligent, able to interest her patient, to read aloud, and to write letters. The more of these cases she has seen and nursed, the easier becomes the task of the doctor. Young, I have said she ought to be, but youthful would be a better word. If, as she grows older, the nurse loses the strenuous enthusiasm with which she made her first entrance into her work, scarcely any amount of conscientious devotion or experience will ever replace it; but there are fortunate people who seem never to grow old in this sense. It is always to be borne in mind that most of these patients are over-sensitive, refined, and educated women, for whom the clumsiness, or want of neatness, or bad manners, or immodesty of a nurse may be a sore and steadily-increasing trial. To be more or less isolated for two months in a room, with one constant attendant, however good, is hard enough for any one to endure; and certain quite small faults or defects in a nurse may make her a serious impediment to the treatment, because no mere technical training will dispense in the nurse any more than in the physician with those finer natural qualifications which make their training available. Over-harshness is in some ways worse than over-easiness, because it makes less pleasant the relation between nurse and patient, and the latter should regard the former as her "next friend." Let the nurse, therefore, place upon the doctor the burden of decision in disputed matters; his position will not be injured with the patient by strict enforcement of the letter of the law, while the nurse's may be. But one nurse will suit one patient and not another: so that I never hesitate to change my nurse if she does not fit the case, and to change if necessary more than once.

The degree of seclusion should be prescribed from the first, and it is far better to find that the original rules may be profitably relaxed than to be obliged to draw the lines more strictly when the patient has at first been indulged. For instance, it is well to forbid the receipt of any letters from home, unless anxious relatives insist that the patient must have home news. In that case the letters should be mere bulletins, should contain nothing, no matter how trifling, that might annoy a too sensitive person, and, most important of all, should come to the nurse and by her be read to the patient. _

Read next: Chapter 5. Rest

Read previous: Chapter 3. On The Selection Of Cases For Treatment

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