The regular daily care of the patient and of his room, already described in this book, should be scrupulously carried out, and no less scrupulously during the tenth year than it was during the tenth day. Cleanliness in every detail is absolutely essential to the patient's welfare; no one is more unpleasant either to himself or to others than a chronic patient who is neglected. Patients who are constantly in bed, it should be remembered, and paralyzed patients in particular, are peculiarly susceptible to pressure sores. If a patient is able, it is extremely important for him to sit up in a chair part of the day. Sitting up should never be omitted because it involves the expenditure of time and trouble for the attendant. It is often said that for most people some personal experience of sickness is beneficial; it can safely be said, however, that no one benefits from spending any considerable portion of his life in a state of helplessness and suffering. Behavior and character itself are determined by influences constantly coming into the mind from daily surroundings and associations with other people: one who recalls this fact needs only a moment's reflection to realize how ill adapted to healthy development of mind and character are the limited lives of the sick. Especially unfortunate is the situation of chronic invalids, shut off as they are from the objective interests and activities of normal life, deprived of all practice in making the salutary small adjustments and sacrifices required in every day living with other people, and self-centered as they necessarily tend to become from the inevitable focusing of attention upon their own discomforts and pain. On the whole, a surprisingly large number of invalids successfully resist the disintegrating effects of sickness upon character. But it is nevertheless true, as Dr. Weir Mitchell says, that "Sickness ennobles a few but debases many." A selfish invalid has more than once destroyed the happiness of an entire family, or spoiled the life of one member of it by monopolizing her whole time and attention. Families should remember that their injudicious sacrifices seldom bring enduring happiness or contentment to the patient himself; indeed, in the long run such sacrifices generally injure him even more than they injure his victims. Clearly much must and should be sacrificed by members of a family to the needs of an invalid; but in general it may be said that a sacrifice is injudicious if it relieves the patient of activity or responsibility that he can support without injury, if it makes him more dependent in mind or body, if it results in restricting his attention to himself and his affairs, or if it increases his tendency to make demands on others.