Cardiac rehabilitation

I have read the editorial in the October BJGP with great interest;¹ I first applied the rehabilitation process in 1945.

Having served in three small ships I was appointed medical officer in charge of a Royal Naval convalescent home and approximately 100 beds for ratings recovering from general surgery, orthopaedic surgery, and medical cases.

Having been inspired by my previous teaching as a house surgeon, by a consultant who, influenced by the Liverpool team practiced rehabilitation and its motto ‘Return to Full Function’. Thus fortified, I altered the focus of a ‘convalescent home’ and together with an excellent chief petty officer physiotherapist we set about rehabilitating every suitable case.

One medical case was an older chief petty officer steward, aged about 50 years, who had suffered a severe coronary thrombosis. He was bed bound and had been treated at the Royal Navy Hospital Haslar; he was sent for my care in the convalescent home in the expectation that recovery was unlikely. I waited for him to settle down and over the next week we gave him very simple hand and arm exercises. Monitoring pulse and blood pressure meantime, there were no sophisticated aids to diagnosis at that time. His response to light upper limb exercises were satisfactory, so progressive exercise over the next 6 weeks gave us hope that the damaged heart muscle had healed. The neurology was intact so he was progressively mobilised and deemed suitable for discharge home. I informed the senior medical physician at Haslar. He was amazed but agreed. It is a pity I was unable to follow him up further. I think he was honourably retired on medical grounds. I tell this story because it brings me to encourage the cult of rehabilitation and the effect it had on my future thinking; it certainly wasn't mentioned at Guys during my training there.

When I joined my practice I visited about 80 older patients, who were either bed bound or chair bound, to give them their ‘pills’. This seemed a rather uneconomic way of spending my time so, in order to put some sort of ‘clinical label’ upon each of them, I arranged to visit them with the nearest relative I could find, examine them from top to toe, suggesting to the relatives that their elders were wasting a perfectly good life, and set about curing them. Once they were all reassured that the ‘reaper was not nigh’, a great change in situation took place. They got out of their beds by easy stages, out of their chairs, went outside in the fresh air, threw away most of their pills, made life a lot easier for their relatives (and the doctor!) and started to live again. None of them died except one; who having spent about 18 months out and about had a stroke while walking in town. Her relatives came to me for the death certificate, and I wondered if I would be treated for activating too soon; no, they thanked me for giving her another year of ‘full life’! This first 18 months before the NHS started was hard work but rewarding in that rehabilitation won the day. Not only did I have to change attitudes among the ‘flock’ but in my seniors; I never realised that I had so many resources of tact!

This brings me to Hugh Bethell's article in the October issue, which is mainly related to cardiac disease. I would like to suggest it should have a much wider application. Any disorder which keeps the whole mind and body out of action for a week or more should be treated by simple, easily understood movements of all limbs. There is no magic about it. It does not require medical specialists, health visitors, district nurses, or physiotherapists. We should encourage mental and suitable physical activity to retain the patients interest in recovery of mind. Reading, crosswords, and puzzles are far better than sleeping pills, building up the pace as recovery proceeds.

We need to encourage our health visitors, midwives, district nurses, and relatives to think on these lines. The word rehabilitation may be too big a pill to swallow, so I suggest it is not used for patient consumption.