CLINICAL SYNDROMES 365 



of ligation of one or more vessels, lobectomy or thyroidectomy and 

 sympatheticotomy. 



General Measures. Rest. Both physical and mental rest is clearly in- 

 dicated for the important symptoms of muscular weakness, the disordered 

 heart action, the nervous irritability and the increased metabolism. Of 

 course the degree of rest must be determined for each type of case. In the 

 severe intoxication a rigid Weir Mitchell rest-cure is indicated; this im- 

 plies isolation in a hospital, preferably in a separate room, with a tactful, 

 patient and well-trained nurse in charge; complete bed rest must be 

 insisted upon with only the mildest of relaxation as reading, knitting or 

 basket-work. All visitors, letters, business worries and household cares 

 must be excluded. In the milder cases bed rest should be required at 

 fixed hours when possible, and when not possible the patient should be 

 ordered to go to bed as soon as the day's work is over. Late hours must be 

 prohibited, and if on occasion they are necessary, they should be preceded 

 and followed by a rest of sufficient length to compensate for the loss 

 sustained. The patient should be instructed to lie down rather than to 

 sit, to sit rather than to stand, and, above all, to avoid stair-climbing as 

 far as possible. 



Exercise should not be permitted at first ; massage and passive move- 

 ments may be substituted for a time. Moderate massage is useful in 

 cases in which absolute rest in bed is necessary. After distinct improve- 

 ment has been noted, gradually increased exercise should be encouraged. 

 Detailed instructions as to the kind and amount of exercise must be given 

 to the patient, based upon the amount of work necessarily called for by 

 his mode of life. Both work and exercise should stop short of fatigue. 

 It is well to advise against coitus. 



Mental rest is just as necessary as physical. In the severe cases rigid 

 seclusion is advisable ; in the less severe an avoidance of all unnecessary 

 activity must be enacted; necessary occupations can be followed and 

 cheerful companionship should not be shunned; however, exciting and 

 depressing occupations should be given up, temporarily at least. A change 

 of scene, as a visit to Europe, to the Bermudas, Southern California or 

 Florida, is often helpful, provided the patient travels by easy stages and 

 in a leisurely manner. 



Fresh Air. Fresh air is an essential of the rest treatment. The bed 

 room should be well aired or, better still, the patient should sleep out of 

 doors on a sleeping porch. During the day the milder, case should be 

 encouraged to walk or drive or, in the event of these being too tiring, he 

 should be encouraged to sit out of doors well protected from cold and 

 wind. As far as climate is concerned, the ideal one includes moderate 

 elevation (1,500-2,000 feet), pure cool air, and a freedom from much 

 wind. The seashore and high altitudes are not well borne because of the 

 cardiac and nervous symptoms. However, no rule can be laid down where a 



