Abstract

Until recently it was generally accepted that bed rest was a valuable part of treating all ill patients. Textbooks stated dogmatically that bed rest - often for weeks or months - was essential for a wide range of maladies, including hepatitis, acute bronchitis,¹ measles, ² subarachnoid haemorrhage,³ acute cholecystitis⁴ and fever.⁵ The evidence to support this view was rarely if ever produced. Protein synthesis is increased during sleep in animals⁶ but it is not clear how this finding relates to bed rest in man. Even when it had become accepted that controlled trials were needed to evaluate drugs for acute and relapsing conditions, rest remained sacrosanct. Thus, in a multicentre controlled trial in rheumatic fever the value of salicylates and corticosteroids was assessed but bed rest was not. Bed rest was considered an ‘essential part of treatment’ in patients with rheumatic carditis.⁷