THE BED

NASA TECHNICAL TRANSLATION

NASA TT F-15,582

THE BED

,„Si-TT-T-15582, THE BED (Ka»nex^<xeoK

associates) 7 p HC »t».uu

H7tt-22717^

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G3/0t* 38395

Translation of "Die Bed/' Editorial in South "Africa Medical
Journal, Vol. 43, No. 11, March 1969, PP 289-290

NATIONAL AERONAUTICS. AND SPACE. ADMINISTRATION
WASHINQTONv D.C 2Q.5.45 mX 1974

STANDARD TITLE PAGE

1. Report No.

NASA TT P-15,582

2. Cov«mm*nr Accastion No.

*■ Tifle and Sublill*

THE BED

7. Aurtior(s)

(editorial)

9. Performing Orgoniiotion Noma and Addrets

Leo Kanner Associates, P.O. Box 51^7,
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NATIONAL AERONAUTICS AJSfD SPACE ADMINIS-
TRATION, WASHINGTON, D.C. 20546

3. f?«cfpienf'B Cotofe^ Ho.

5. Rworf Dqf*,

May 1974

6. Parferming Organriotion Cod*

S. Parforming Organ)iatien Roport No,

10. Work Uni4 No.

M^T-k'n^r'*"-

13. Typ« o* Report ond Poriod Covorod

Translation

14. Sponioring Agancy Cod*

IS. Supplomontary Notes

Translation of "Die Bed," Editorial In South Africa Medical
Journal, Vol. 43, No. 11, March 1969, PP. 289-290.

16. Abstract

This editorial
of bed rest on
Increases by. 30
control of vase
calcium and nit
found In older
the therapeutic
of its efficacy
planning.

discusses some of the pathological effects
the patient: the heart's work production
% In the prone position; autonomic nervous
ular tonus is curtailed; excretion of
rogen Increases; incontinence Is often
patients. Recent considerations about

value of bed rest, and a re-evaluatlon
, will give rise to changes In hospital

17. Key Words (Selected by Aulhor(t)l

19. Socurity Cloiftif. (of this report)

Unclassified

18. Diilributlen Statemenl

20. Security Clotsif. (of thi> page)

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2). No. o( Page*

7

22. Price ■

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THE BED

Cli.nlca,! jri^aiciAe ts bound in word ana .deea to: the bed,. In /Z^S'
word because the Qreek. word from which It .is: derived, kllne ; means
bed. And In deed because the success of a physician Is judged by
his behavior and proficiency at the bedside. We express the size
of hospitals in terms of the number of beds they have, and the
seniority of specialists can be determined most often by the
number of beds under their care. Often an illness that does not
require bed rest will not qualify for sick-leave benefits. The
first reaction of an ill or Injured person Is In fact to lie down,
and upon admission to a hospital, the patient Is routinely con-
fined to bed until the physician explicitly agrees that the
patient may be allowed to get up.

According to Asher [1], however, bed rest must never be
acceptable as routine. It must be prescribed, Just like digitalis
or morphine, since the side-effects might be Just ad, dangerous
as the indiscriminate use of any new-fangled remedy. He also
emphasizes the fact that physicians must re-evaluate their opinions
of bed rest In light of newer. .developments. Thus, for example,
Illingworth [2] doubts the value of bed rest for the four general
childhood illnesses: measles, chicken pox, mumps, and German
measles. Often when we consider Iatrogenic disorders, and even
suspect the traditionally safe aspirin, it is:'p,articularly odd
that the general prescription, namely bed rest. Is seldom discussed.

Bed rest as a form of therapy acquired its scientific recogni-
tion when In 1863 John Hilton published his essay, "Rest and Pain."
Critics have explained that "no one before or since has ever
preached th.e gospel of rest so refreshingly, so effectively or
so convincingly as John Hilton."' The fundamental drift of the
- work Is that Joints-: -affected by arthritic pain require re at. The
*Numbers- in the ma^gi,^ Indicate pagination In the "foreign text.

principle was alBO' successfully' ■applied to tuberculosis at the
beginning of this century-, when fresh air, good, food and rest
had to be used in place of today's streptoniycln, INH and parar-;amino-
sallc^;lic acid. Rest was also promoted through such procedures as
pheumothorax, thoracoplasty and contusion of the N. f^hrenicus [3]»

The dangers of bed rest were first evidenced in the geriatric
patient, since the older person*s resistance to noxious Influences
is less than that of the younger person. Unfortunately, it is still
standard practice that on any important occasion the nurse will
pack the patients in her ward back into their beds like dishes Into
a cupboard. It Is, however, encouraging that In the past few
years the bed as a form of therapy has been critically re-evaluated.
We are all familiar ywlth the dangers of aspiration pneumonia, deep
venous thrombosis, lung embolism and bed sores as complications of
prolonged bed rest.

Work physiologists contend that maximal oxygen uptake of
patients with myocardial infarction diminishes In proportion to
the duration of Imposed bed rest. The work production of the
heart increases by 30^ when the patient assumes the pirone; position,
and we know that after prolonged bed rest the patient's autonomic
nervous control of vascular tonus is curtailed such that syncopy
generally appears when the patient stands. For this reason there
is today a tendency to attend to patients in a chair rather than
in a bed [4],

The toddler is taught from the start not to pass urine or
feces in a reclining position. With Illness in the aged, however,
we expect that this life-long taboo will be thrown overboard
and the patient will relieve himself in this way. For a stout
person, balancing on the bedpan requires as much energy as would
b-e used by a circus tightrope walker ^ one considers, then, how

much rest actually occurs* It need, not amaze .us that after a
period of bed rest the aged patient is incontinent. After Just
4 days- in the reclining position, the excretion of calcium
increases. The position of the kidney Is such that the calyx
lies lower than the renal pelvis , and kidney stones can readily
be formed. Constipation as a complication of bed rest is well
known, and the habit of using laxatives Is often acquired in
the hospital [3].

The excretion of nitrogen increases after 4 days in bed to
reach a maximum after 2 weeks. If the patient at this stage is
mobilized^ it takes a month before the body regains a positive
nitrogen balance. The amount of nitrogen thus lost agrees with
a loss of 4 pounds of muscle tissue [3].

The misshaping of Joints, which like bed sores is a result
of prolonged bed confinement, is largely prevented by good and
devoted nursing care, hut the danger of complications is directly
proportional to the duration of bed confinement.

Often we tend to overlook the psychic results of bed rest.
But we do know how the bed-ridden patient is restless at night
and requires sedation in order to sleep. A half hour or so in
a chair often can replace the nighttime sleeping pill. The
various ways in which mobilization after a period of bed rest
supports a patient morally can hardly be exaggerated, and it also
protects: against the resignation with which so-many chronic
patients- accept their lot. It rouses new spirit and cooperation
with, the nursing staff when we get such a patient out of his bed.

Recent considerations about the therapeutic value of .bed
rest according to Asher 1X2 will give, rise to changes in hospital
planning. Thus- a dormitory- with a comfortable s.ttting room and
walkway will po&sibly characterize the hospital of the future.

Before it can, happen, however, physicians and nurses must learn
that bed, rest must only be prescribed with forethought and must
never be accepted as a self-evident necessity. We shall also
have to realize that much of the success of modern methods can
be attributed to the fact that bed confinement of patients has
been shortened.

In conclusion, we must all learn to see the bed-ridden
patient with the eyes of Asher: "Look at the patient lying in bed.
¥hat a pathetic picture he makes. The blood, clotting In his /280
veins, the lime, draining from his bones. The scybala, stacking
up his colon, the flesh rotting from his sweat. The urine leaking
from his distended bladder, and the spirit, evaporating from his
soulIf''[l]. Then we shall all learn to say to the patient the
words of the Great Physician: "Take up tliy bed and walk."

REFERENCES

1. Aaher, R.A, J. , Brit.. Med^ J. 4,. 9^7 (1967).

2. llilngwortli, R.3 fbl.d. k> 4l (156?).

3- Schouten, J. and J.T.R. Schreuder,' Ked.' T.' Geneesk.' .llS, 1337
C19683. ■

4. Browse, N.L.,' The physiology' and pathology 'of bed rest ,
Spr Ingf le Id , 111. / Charles C. Thomas, 1965.