IX

ON SLEEPING OUT

"Now blessings alight on him that first invented this same sleep. It covers a man all over, thoughts and all, like a cloak; it is meat for the hungry, drink for the thirsty, heat for the cold, and cold for the hot. It is the current coin that purchases all the pleasures of the world cheap, and the balance that sets the king and the shepherd, the fool and the wise man, even."

THE idea of sleeping out as an aid in the treatment of pulmonary tuberculosis was first put into practice in the Rocky Mountains, but has since spread over America. The exhilarating effect of life in the open has long been dwelt upon by sportsmen, and these two factors have influenced many persons in apparently perfect health to take it up. In fact today a considerable percentage of suburban houses are provided with sleeping-out porches. As a means of raising the resistance of an individual to tuberculosis it is very valuable. Many and varied devices for pursuing this have been put upon the market and have been referred to previously (page 57). Beds which can be pushed partly out of the window and window tents are far less valuable than a good porch. The advantages of sleeping out have been emphasized, if not overemphasized. For the invalid it has been pointed out that he is

out of doors twenty to twenty-four hours a day, where usually the ventilation is perfect. On the other hand, as many conditions arise which render it inadvisable, a physician should be consulted about it by every patient. Some patients cannot sleep out of doors, and sleep must be had. The early morning light, the noises, the wind, the rise of temperature on some nights, all disturb sleep. Still it can in most cases be arranged for. A few suffer from catarrh and have difficulty in breathing through the nose. For these sleeping out should be postponed. Some patients have occasionally to arise at night, and for these the danger of exposure and chilling is considerable. There is also an objection which may be theoretical. Cool, fresh air acts like a tonic upon relaxed muscles and quiets often an overwrought nervous system. The loss of heat in the cold, fresh air is much greater than in a room. The loss of heat must be provided for and to produce more heat the muscles remain in a state of prolonged slight contraction known as "tone.' That this might be too prolonged in a weak patient is easily conceivable, and the ten to twelve hours indoors at night in a cool, fresh room certainly works no harm. In my experience I have seen many patients sleep out and many sleep in. I have tried to observe if any difference in the rapidity of healing occurred, but have not been able to do so, provided, of course, that the patients sleeping indoors spent

eight to ten hours a day in the open and slept in well-ventilated rooms.

The great advantage of sleeping out is obtained not by the patient who has all day to be out of doors, but by him who through lack of funds or through other unfortunate circumstances must be indoors nearly the whole day and often in a crowded store or office. He gets no fresh air and has no time to get it except at night. Here sleeping out or in may decide whether or not he remains well. For such a patient sleeping out if at all possible should be pursued. For another man who works, say, indoors and out, and at night must sleep either indoors in a poorly ventilated or overcrowded room or outdoors, the question can be easily decided. The establishment of "sleeping-out" sanatoriums or "night" sanatoriums has been begun and should be pushed. Patients who cannot afford to sleep out after working indoors would here have an opportunity.

NIGHT AIR

Night air has long been avoided as dangerous. Why it should be so considered is not difficult to discover. On the Roman compagna it means or meant malarial fever to spend a night or many hours in the open. Today it is recognized that this has nothing to do with the quality of the night air, but to the fact that at dusk the malariabearing mosquitoes leave their hiding or resting

places and begin to bite. As a matter of fact the night air is often purer than the day air. As traffic lessens, the production of dust is less, and the factories and foundries frequently bank their fires at night, and hence the night air contains usually far less dust and less smoke and gas. So fortunately for us when we must choose between pure night air outdoors or impure night air indoors, the choice is easy.

DRESSING FOR SLEEPING OUT

In making these or other suggestions for sleeping or sitting out, a climate where the mercury drops often in winter to zero is considered. For those who reside in a less rigorous climate this fact must be taken into consideration. Individuals vary greatly in their sensitiveness to cold and again some are warm during the day, and cold at night or conversely, which makes it clear that no hard-and-fast rules in regard to night (or even day) clothing, etc., can be made. Each person sleeping out must be guided more or less by his own comfort, facilities, and resources. While I have seen patients, who in zero weather could sleep out in a thin cotton nightgown between cotton sheets and be comfortable, the majority cannot keep warm in bed in cold weather unless warmly dressed. In fact, many have to dress especially for such a life, though each person is a law unto himself. Some must

wear woolen underwear, woolen socks, stockings or bed slippers, outing flannel or flannel pyjamas, the legs of which are tucked into the socks, a woolen sweater, and a sleeping hood or helmet with a long neck-piece or cape which falls down over the shoulders and fits under the collar of the sweater. To protect the nose, some like a domino mask lined with flannel. Eiderdown leggings or boots which reach to the hips are convenient to wear between the room and the bed, or even on very cold nights in bed. Some patients prefer a woolen bath-robe to some of the garments mentioned. A knitted combination suit with feet, gloves and hood attached (llama wool garments), can be purchased, and for very cold weather may be desirable. These are only a few of a thousand and one devices for being comfortable in bed out of doors. A "Black Knight" to keep the early morning light from awaking the patient is often useful and has been mentioned. An application of cold cream to the face some find helpful.

THE BED

When a patient is up and about, the bed is of far less importance than when he must spend twenty-four hours a day in it. For invalids confined to bed the best is none too good. The hospital bed is of great advantage as it adds much to the ease with which the patient can be cared for.