The Left Atrium
http://www.100md.com
《加拿大医疗协会学报》
Iwas brought up in an English boarding school whose attitudes and initiations were dedicated to "muscular Christianity" and the principle that early to bed and early to rise would make a man healthy, wealthy and wise. Somewhat later, when I was at medical school, I was exposed to Professor R.S. Illingworth's idea that it was unnecessary and usually futile to attempt to keep recuperating children in bed. But it was the physician and essayist Richard Asher who really spilled the beans about the malevolent effects of bedrest with an article in a 1947 issue of the British Medical Journal. "Look at a patient lying long in bed," he writes. "What a pathetic picture he makes of blood clotting in his veins, the lime draining from his bones, the scybala stacking up in his colon, the flesh rotting from his seat, the urine leaking from his distended bladder and the spirit evaporating from his soul.1 Is it not surprising, therefore, that for many years I was of the opinion that time spent on a palliasse was a waste." This attitude predominated for several years, to the point where I briefly considered taking up jogging.
Providentially, I mentioned this mental aberration to another expatriate, who jogged the memory of a talk given by Cecil Woodham-Smith on the BBC sometime in the late 1950s. Although both of us remembered his account with pleasure, it was my discerning colleague who called attention to the crucial message.
Woodham-Smith had imparted the information that certain resolved men and women whose accomplishments were renowned had in fact spent the greater part of their lives ignoring fresh air, circumventing exercise as if it were some contagion, and lolling on either a bed or a sofa. Among the personnages she chose as examples were Elizabeth Barrett Browning, Florence Nightingale, Charles Darwin and Harriet Martineau.
Even those who have seen The Barretts of Wimpole Street might not know that Elizabeth Barrett Browning spent three-quarters of her life in a darkened room from which the sun was carefully excluded. As if blinds were insufficient, the ivy that covered the house on Wimpole Street was carefully nurtured so as to form a light, impermeable mesh over the closed windows. There the poet lay wrapped in shawls, sharing with her spaniel, Flush, the stale and stuffy air. The room remained undusted year round, and she adopted as pets the many spiders that abounded. According to Woodham-Smith, when Elizabeth Barrett wrote a letter, as often as not she indicated the year incorrectly. Deluding herself that she had some dread spinal disease, she hibernated until Robert Browning entered her life. Within the space of twelve months she had eloped and settled down to a happy married life.
It might be said that, as Elizabeth Barrett Browning was a poet, her odd behaviour was perhaps to be expected, but such an expectation cannot be laid at the door of Florence Nightingale, who if nothing else was certainly a woman of action and influence.
From her bed, Nightingale influenced Cabinet decisions and appointments and was instrumental in devising and modifying much new legislation. In 1857 she decided she had heart disease; she gave away her goods and chattels, made her will and resigned herself to taking leave of the world. At three-to four-year intervals thereafter she continued to give away her possessions and to rewrite her will, until eventually she died, in 1910, at the overripe old age of ninety-plus. Her room at Dorchester House, now the site of the Dorchester Hotel, was meticulously kept, the windows thrown wide open with sunlight streaming in, her dressing table covered with flowers and tastefully decorated. She was regularly visited by prime ministers, home secretaries and commanders-in-chief, but only under sufferance and only on her conditions. The volume memoranda, correspondence and reports turned out by Florence Nightingale would shame even a modern civil servant. According to Woodham-Smith, her Indian Sanitary Report filled 1000 pages with closely written script. There is little doubt that Florence Nightingale could never have been as productive nor achieved as much had she risen from bed to lead the vapid and vacuous life of an upper-class Victorian woman.
Charles Darwin represents a forme fruste of the "let's to bed" syndrome. In his early twenties he came to believe he had heart disease, despite the fact that his family and friends stated that his appearance was one of rude good health. The arduous physical demands made on Darwin during his five years as a seafaring naturalist, graphically described in Alan Morehead's Darwin and the Beagle, are hardly compatible with organic heart disease. On his return, Darwin complained persistently of headaches, lethargy, insomnia and dizziness. Even a short visit from a friend would lead to a sleepless night. Although many theories as to the nature of Darwin's illness have been propounded, with diagnoses ranging from Chagas disease to myocarditis, Sir George Pickering argued in Creative Malady (1974) that Darwin's symptoms were entirely functional. At age 30, Darwin married Emma Wedgwood — reputedly, the marriage of the perfect nurse with the perfect patient. Shortly thereafter he retired to Kent, finding London too tiring. There he evolved a routine that started early each morning with two hours of work or experimentation, after which he took to the sofa until lunch. After lunch he retired to his bedroom for another two or three hours, only to rise refreshed and ready for a vigorous game of backgammon or chess. Victorian volumes proved too heavy for him to hold and were cut in half so that he might avoid collapsing from the fatigue engendered by such heavy weights. Working two hours a day, he made monumental scientific contributions; one cannot but wonder what he might have achieved had he worked for sixteen hours a day as do most modern tycoons — probably nothing!
Harriet Martineau became deaf at the age of twelve and not long after found herself financially responsible for her whole family. The stress of the situation caused her to develop fainting spells and a weak heart, and she retired to bed. After six years, the family finances had improved and her mother had moved in with relatives; obviously, the time was ripe for a cure. And so the cure came about, Harriet attributing it to mesmerism. She went on to become a journalist, novelist and political economist. Besides her job with The Daily News, she wrote numerous books, dined out every weekday, spent a large portion of her time travelling and conducting interviews, and all in all led a most active life.
The sage counsel of the Sleepy-head of nursery lore, namely, "Come, let's to bed," seems to have been too long ignored. What great work of art or important scientific theory came into existence or was formulated while jogging? Surely there is a lesson to be learned from the behaviour of these four illustrious persons. It would appear that bodily activity and physical enthusiasm are seldom productive, whereas great thoughts may come to mind if one lies long enough in bed.
REFERENCE
Asher RAJ. The dangers of going to bed. BMJ 1947;2:967.
Providentially, I mentioned this mental aberration to another expatriate, who jogged the memory of a talk given by Cecil Woodham-Smith on the BBC sometime in the late 1950s. Although both of us remembered his account with pleasure, it was my discerning colleague who called attention to the crucial message.
Woodham-Smith had imparted the information that certain resolved men and women whose accomplishments were renowned had in fact spent the greater part of their lives ignoring fresh air, circumventing exercise as if it were some contagion, and lolling on either a bed or a sofa. Among the personnages she chose as examples were Elizabeth Barrett Browning, Florence Nightingale, Charles Darwin and Harriet Martineau.
Even those who have seen The Barretts of Wimpole Street might not know that Elizabeth Barrett Browning spent three-quarters of her life in a darkened room from which the sun was carefully excluded. As if blinds were insufficient, the ivy that covered the house on Wimpole Street was carefully nurtured so as to form a light, impermeable mesh over the closed windows. There the poet lay wrapped in shawls, sharing with her spaniel, Flush, the stale and stuffy air. The room remained undusted year round, and she adopted as pets the many spiders that abounded. According to Woodham-Smith, when Elizabeth Barrett wrote a letter, as often as not she indicated the year incorrectly. Deluding herself that she had some dread spinal disease, she hibernated until Robert Browning entered her life. Within the space of twelve months she had eloped and settled down to a happy married life.
It might be said that, as Elizabeth Barrett Browning was a poet, her odd behaviour was perhaps to be expected, but such an expectation cannot be laid at the door of Florence Nightingale, who if nothing else was certainly a woman of action and influence.
From her bed, Nightingale influenced Cabinet decisions and appointments and was instrumental in devising and modifying much new legislation. In 1857 she decided she had heart disease; she gave away her goods and chattels, made her will and resigned herself to taking leave of the world. At three-to four-year intervals thereafter she continued to give away her possessions and to rewrite her will, until eventually she died, in 1910, at the overripe old age of ninety-plus. Her room at Dorchester House, now the site of the Dorchester Hotel, was meticulously kept, the windows thrown wide open with sunlight streaming in, her dressing table covered with flowers and tastefully decorated. She was regularly visited by prime ministers, home secretaries and commanders-in-chief, but only under sufferance and only on her conditions. The volume memoranda, correspondence and reports turned out by Florence Nightingale would shame even a modern civil servant. According to Woodham-Smith, her Indian Sanitary Report filled 1000 pages with closely written script. There is little doubt that Florence Nightingale could never have been as productive nor achieved as much had she risen from bed to lead the vapid and vacuous life of an upper-class Victorian woman.
Charles Darwin represents a forme fruste of the "let's to bed" syndrome. In his early twenties he came to believe he had heart disease, despite the fact that his family and friends stated that his appearance was one of rude good health. The arduous physical demands made on Darwin during his five years as a seafaring naturalist, graphically described in Alan Morehead's Darwin and the Beagle, are hardly compatible with organic heart disease. On his return, Darwin complained persistently of headaches, lethargy, insomnia and dizziness. Even a short visit from a friend would lead to a sleepless night. Although many theories as to the nature of Darwin's illness have been propounded, with diagnoses ranging from Chagas disease to myocarditis, Sir George Pickering argued in Creative Malady (1974) that Darwin's symptoms were entirely functional. At age 30, Darwin married Emma Wedgwood — reputedly, the marriage of the perfect nurse with the perfect patient. Shortly thereafter he retired to Kent, finding London too tiring. There he evolved a routine that started early each morning with two hours of work or experimentation, after which he took to the sofa until lunch. After lunch he retired to his bedroom for another two or three hours, only to rise refreshed and ready for a vigorous game of backgammon or chess. Victorian volumes proved too heavy for him to hold and were cut in half so that he might avoid collapsing from the fatigue engendered by such heavy weights. Working two hours a day, he made monumental scientific contributions; one cannot but wonder what he might have achieved had he worked for sixteen hours a day as do most modern tycoons — probably nothing!
Harriet Martineau became deaf at the age of twelve and not long after found herself financially responsible for her whole family. The stress of the situation caused her to develop fainting spells and a weak heart, and she retired to bed. After six years, the family finances had improved and her mother had moved in with relatives; obviously, the time was ripe for a cure. And so the cure came about, Harriet attributing it to mesmerism. She went on to become a journalist, novelist and political economist. Besides her job with The Daily News, she wrote numerous books, dined out every weekday, spent a large portion of her time travelling and conducting interviews, and all in all led a most active life.
The sage counsel of the Sleepy-head of nursery lore, namely, "Come, let's to bed," seems to have been too long ignored. What great work of art or important scientific theory came into existence or was formulated while jogging? Surely there is a lesson to be learned from the behaviour of these four illustrious persons. It would appear that bodily activity and physical enthusiasm are seldom productive, whereas great thoughts may come to mind if one lies long enough in bed.
REFERENCE
Asher RAJ. The dangers of going to bed. BMJ 1947;2:967.