A Note on Early Rising after Cœliotomy. *

IN July 1909 I first began to encourage post operative patients to leave their beds at dates earlier than had been up to that time usual after major operations. Formerly the sojourn in bed extended generally to three and sometimes four weeks, and it waa certainly never less than two. In the case of women whose muscular powers were already lessened by disease or by inability to take even such exercise as the performance of household duties implied, so long a period of inactivity accentuated the muscular weakness. Such patients, on rising from bed at the end of three weeks' inactivity, are usually enfeebled to a marked extent, for their muscles are suffering from disuse, and there then occurs the realization that one disability (disease) has been exchanged for a lesser (muscular weakness), Some patients, usually the younger ones, recover fairly quickly : the majority regain strength after some months, and a few only after a year or more. Until renewal of power is acquired muscular exercise is frequently followed by fatigue, aching or even pain, any of which may be regarded by the patient as an indication that the operation has not been successful. No doubt massage and the careful practice of simple muscular exercises would lead to rapid improvement, but massage is as far beyond the pocket as muscular exercises are beyond the comprehension of the average hospital patient. In all case patients were merely encouraged to leave their beds, nothing suggestive even of compulsion being employed. As a rule the simple suggestion of getting up was accepted with eagerness, and indeed many begged for permission to leave bed before they were really fit to do so. In estimating the fitness of a patient for early