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FAT AND BLOOD:
AND
HOW TO MAKE  THEM.
              BY



     S. WEIR MITCHELL, M.D.,

MEMBER OF THE NATIONAL ACADEMY OF SCIENCES; PHYSICIAN TO THE ORTHOP<EDIC
HOSPITAL AND INFIRMARY FOR DISEASES OF THE NERVOUS SYSTEM; FELLOW OF
 THE PHILADELPHIA COLLEGE OF PHYSICIANS; MEMBER OF THE AMERICAN PHIL-
 OSOPHICAL SOCIETY; MEMBER OF THE NEW YORK ACADEMY OF MEDICINE;
  ASSOCIATE FELLOW OF THE AMERICAN ACADEMY OF ARTS AND SCIENCES,
  BOSTON; HONORARY MEMBER OF THE NEW JERSEY STATE MEDICAL SO-
  CIETY ; HONORARY CORRESPONDING MEMBER OF THE BRITISH MEDICAL
   ASSOCIATION ; HONORARY MEMBER OF THE ST. ANDREW'S MEDICAL
   GRADUATES' ASSOCIATION ; FOREIGN ASSOCIATE OF THE ROYAL
    MEDICAL SOCIETY OF NORWAY; AUTHOR OF "A TREATISE ON
     INJURIES OF THE NERVES," " WEAR AND TEAR," ETC.
J. B. LIPPINCOTT & CO.
         1877. 
 Mon. Mel.
•WM
Copyright, 1877, by J. B. Lippinoott & Co. 
DEDICATION.
                  TO

     JOHN FORSYTH  MEIGS, M.D.,

, IN GRATEFUL REMKMBRANCE OF MANY ACTS OF FRIENDLY
                SERVICE.

          S. WEIR MITCHELL.
3 
 
CONTENTS.
                                               PAGE
                  CHAPTER  I.
Introductory   ........7

                 CHAPTER  II.
Fat in its Clinical Relations    .    .    .    .    9

                CHAPTER  III.
Seclusion.........34

                CHAPTER  IV.
Rest..........36

                 CHAPTER  V.
Massac e.........51

                CHAPTER  VI.
Electricity.........62

                CHAPTER VII.
Dietetics  and Therapeutics—General Results—
  .  Cases.........71
                        1*                 5 
 
FAT   AND   BLOOD:
                  AND
     HOW TO  MAKE  THEM.
               CHAPTER  I.

                INTRODUCTORY.

  For some years I have been using with success, in
private and  in hospital practice, certain methods of
renewing the vitality of feeble people by a combina-
tion  of entire rest and of excessive feeding, made
possible by  passive exercise obtained  through the
steady use of massage and electricity.
  The cases thus treated have been chiefly women
of the class well known to every physician,—nervous
women, who as a rule are thin, and lack blood.  Most
of them have been such as had passed through many
hands and been treated in turn for gastric, spinal, or
                                         7 
8
ISTRODUCTORV.
 uterine troubles, but who remained at the end as at
 the beginning, invalids, unable to attend to the duties
 of life, and sources alike of discomfort to themselves
 and anxiety to others.
   I do not wish to  be thought of as putting forth any-
 thing very remarkable or original in my treatment
 of rest, systematic feeding, and passive exercise.  All
 of these have been used by physicians; but, as a rule,
 one or more are used without the others, and the
 plan which I have found so valuable, of combining
 these means, does not seem to be generally understood.
 As it  involves some novelty, and  as I do not find it
 described elsewhere, I shall, I think, be doing a ser-
 vice to my profession by relating  my experience.
  In 1875 I published in "Seguin's Series of Ameri-
 can Clinical Lectures," Vol. I. Xo. iv., a brief sketch
 of this treatment, under the heading of " Rest in the
Treatment of Nervous Disease," but the scope afforded
 me was too brief for the details  on a knowledge of
which  depends success  in the use of rest.   I have
been often since reminded of this by the many let-
ters I have received asking for explanations of the
minutiae of treatment, and this must be my apology
for  bringing into these pages a great many partic-
ulars which are no doubt well enough known to the
more accomplished physicians. 
CHAPTER  II.
        FAT IN ITS CLINICAL RELATIONS.

  The gentlemen who have done me  the  honor to
follow my clinical service at the Infirmary for Dis-
eases  of the Nervous  System are well aware how
much care is given to learn whether  or not the pa-
tient is losing or has lost flesh,  is by habit thin or
fat.   This question is one of the  utmost moment in
every point  of view, and deserves a  larger  share of
attention than it receives.  In this hospital it is our
custom to weigh our cases when they  enter,  and at
times afterwards;  but  I  do  not  think that  such is a
constant custom elsewhere.  The mere loss of fat is
probably of  small moment in itself when the amount
of daily food is sufficient for every-day expenditure,
and when the organs  are in condition to  keep up
the supply of fat which we require.  But the steady
or rapid lessening of the deposits of hydro-carbons
stored away  in the areolae of the tissues is of  impor-
tance, as indicating their excessive use or  a  failure
of supply;  and  when this is the case it becomes our
                                           9 
FAT IN ITS CLINICAL  RELATIONS.
   duty to learn the reasons for this striking symptom.
   It  has also, in my  view of it, a collateral value of
   great  import, because it is almost an invariable rule
   that rapid thinning  is accompanied with more or less
   anaemia, and it is rare to see a person steadily gaining
   fat after any pathological reduction of weight without
   a corresponding gain in amount and quality of blood.
   We too rarely reflect that the blood thins with the
   decrease of the tissues and enriches as they increase.
     Before entering into this question further, I  shall
   ask attention to some points connected with the nor-
   mal fat of the human body; and, taking for granted,
   here and  elsewhere,  that my readers are well enough
   aware of the physiological value and  uses of the
   adipose tissues, I shall continue to look at the matter
   chiefly from a clinical point of view.
     When  in any individual the weight varies rapidly
   or slowly, it is nearly always due, for the most  part,
   to a change  in the  amount of adipose tissue stored
   away in the meshes of the areolar tissue.  Almost
*  any grave change for the worse in health is at once.
   betrayed  in most people by a loss of fat, and this is
   readily seen in the altered forms of the face, which,
   because it is the always visible  and in  outline the
 _  most irregular part of the body, shows  first and
   most plainly the loss or gain of tissue.  Fatty matter 
       FAT IN ITS CLINICAL  RELATIONS.     H

is therefore that constituent of the body which goes
and comes most easily.  Why there is in nearly every
one a normal limit to its accumulation we cannot say.
Even in health the weight of men, and still more of
women, is by no means constant, but, as a rule, when
we are holding our own with that share of stored-up
fat which belongs  to the individual we are usually
in a condition of nutritive prosperity, and when after
any strain or trial which has lessened weight  we are
slowly repairing mischief and  laying  by fat we  are
equally in a state of health.  The loss of fat, espe-
cially its rapid or steady loss, nearly always goes along
with conditions which impoverish the  blood, and, on
the other hand, the gain of fat up to a certain point
seems  to  go hand in hand with a rise in all other
essentials of health, and notably  with an improve-
ment in the color and amount of the red corpuscles.
   The quantity of fat which is healthy for the indi-
vidual varies with the sex, the climate, the  habits,
the season, the  time of  life, the race, and  the  breed.
Quetelet1 has  shown that before puberty the weight
of the  male is  for equal ages above that  of the  fe-
male, but that towards puberty the  proportional
weight of the female, due chiefly to  gain  in fat,  in-
1 Sur l'Homme, p. 47, et seq. 
12     FAT IN ITS  CLINICAL RELATIONS.

creases, so that at twelve the two sexes are alike  in
this respect.  During the child-bearing time there is
an absolute diminution  on the part of the female, but
after this time the weight of the woman increases and
the maximum is attained at about the age of fifty.
  Henry Bowditch1  reaches somewhat similar con-
clusions,  and  shows from  much  more  numerous
measurements  of Boston children that growing boys
are heavier in  proportion to  their height than  girls
until they reach fifty-eight  inches,  which is attained
about the fourteenth  year.  Then the girl passes the
boy in weight, which Dr. Bowditch thinks is due  to
the accumulation of adipose tissue at puberty.  After
two or three years more the male again acquires and
retains superiority in weight and height.
  Yet during life there are peculiarities which belong
to individuals and to families.   One group  thins as
life goes on past forty;  another group as surely takes
on flesh ; and the same traits are often inherited, and
are to be  regarded  when the  question of fattening
becomes of clinical or diagnostic moment.   Men, as
a rule, preserve their nutritive status more  equably
than women.   Every  physician  must have  been
struck with this.  In fact, many women lose or ac-
1 Growth of Children, p. 31. 
       FAT IN ITS CLINICAL RELATIONS.    13

quire large amounts of adipose matter without any
corresponding loss or gain in vigor, and this fact per-
haps is related in some way to the enormous outside
demands  made by her peculiar  physiological  pro-
cesses.  Such  gain  in  weight is  a common accom-
paniment of child-bearing, while nursing in some
involves enormous  falling  away,  and its cessation  a
renewal of fat as speedy.   I have also found that in
many  women who are not perfectly well there is  a
notable loss of weight at every menstrual period, and
a marked gain  between these times.
   How much influence the season has, is not as yet
well understood, but in our own climate,  with its
great extremes, there  are some interesting  facts in
this connection.  The wealthy classes are with us in
summer placed in the best circumstances for increase
in flesh,  because it  is not only their season of  least
work,  mental  and  physical, but  because  they are
then for the  most part living in  the country under
circumstances favorable to  appetite and to exercise.
Owing to these fortunate conditions members of the
class in question are apt to gain weight in summer,
although many persons, as I know, follow the general
rule and  lose weight.   But if we  deal with the mass
of men who are hard worked, physically, and unable
to leave the towns, we  shall probably find that  they 
14     FAT IN  ITS CLINICAL RELATIONS.

nearly always lose weight in hot weather.   Some
support is given to this idea by the following very
curious facts.  Many years ago I was  engaged for
certain purposes in determining the weight, height,
and girth of all the members of our city police force.
The examination was made in April and repeated in
the beginning of  October.   Every care was taken
to avoid errors,  but to  my surprise I found that a
large  majority of  the men  had lost weight during
the summer.   The sum total of loss was enormous.
As I have mislaid some of the sheets  I am unable
to give it accurately, but  I  found that  three out of
every five had lessened  in weight.  It would be in-
teresting to know if such a change occurs in convicts
confined in penitentiaries.
  I  am  acquainted with  some  persons who  lose
weight.in winter, and with more who fail in flesh in
the spring, which is our season of greatest depression
in health—the season when choreas are apt to origi-
nate1  or to  recur, and  when habitual   epileptic fits
become frequent in such  as are the victims of that
disease.
   Climate has a good deal to do with a  tendency to
  1 See a valuable paper by Dr. Gerhard.   Am. Journ. Med.
Sci., 1876. 
       FAT IN ITS CLINICAL  RELATIONS.     15

take on fat, and I think the first thing which strikes
an American  in  England  is the number of inordi-
nately fat people, and especially of fat women.
  This excess of flesh  we usually associate in idea
with slothfulness, but English women exercise more
than ours, and live in a land where few days  forbid
it, so that probably such a tendency to obesity is due
chiefly to climatic causes.  To  this also we may no
doubt  ascribe the habits  of the English as to food.
They are  larger  feeders than  we, and both sexes
consume beer  in  a manner which would in  this
country be destructive of health.  These habits  aid,
I suspect, in producing  the more general fatness in
middle and later life, and those enormous occasional
growths which so amaze an American when first he
sets foot in London.  But whatever be the cause, it
is probable that of the prosperous classes English,
over forty, would outweigh the average American of
that  period, and this must make, I should  think,
some difference in their relative liability  to certain
forms of disease, because the overweight of our trans-
Atlantic cousins is plainly due to excess of fat.
  I have sought in vain for English tables giving
the weight of men and women of various heights at
like ages.   The material for such a study of men in
America  is given  in Gould's  researches, United 
16     FAT  IN ITS CLINICAL RELATIONS.
 States  Sanitary Commission,  and  in Baxter's  ad-
 mirable report, but is lacking  for women.   A com-
 parison of  these  points  as between  English  and
 Americans of both sexes, would be of great interest.
   I doubt whether, in this country, as great a growth
 as multitudes of English  attain be either healthy or
 desirable in point of comfort, owing to the  distress
 which  stout people feel in our hot summer weather.
 Certainly " Banting"  is with us a rarely-needed pro-
 cess,  and,  as a rule,  we have  much  more frequent
 occasion to fatten  than to  thin our patients.  The
 climatic peculiarities which have changed our voices,
 sharpened our features, and made small the American
 hand and  foot, have  also made us,  in  middle and
 advanced life, a  thinner and more sallow race, and,
 possibly, adapted us better to the region in which we
 live.   The same changes in  form are in  like manner
showing themselves in the English race in Australia.1

  1 This excess of corpulence in the English is attained chiefly
after forty, as I have said.  The average American  is taller
than the average Englishman, and  is fully as well  built  in
proportion to his height, as Gould has shown.   The child of
either sex in New England is both taller and heavier than  the
English  child of corresponding  class and age, as Dr. Bow-
ditch has lately made  clear; while the English of the manu-
facturing and agricultural classes are miserably inferior to the
members of a similar class in America. 
       FAT IN ITS CLINICAL RELATIONS.    17

   Some  gain in flesh as life goes on  is a frequent
thing here as elsewhere, and usually has no unwhole-
some meaning.   Occasionally we see people past the
age  of sixty suddenly taking on  fat and becoming
at once  unwieldy  and feeble, the fat  collecting in
masses  about  the belly  and  around the  joints.
Such an increase is usually accompanied with fatty
degeneration of the heart  and  muscles, and with a
certain watery  flabbiness in the limbs, which, how-
ever, do  not pit on  pressure.
   Alcoholism also gives rise in some people to a vast
increase of adipose tissue, and the sodden, unwhole-
some fatness of the hard  drinker is a sufficiently
well-known and  unpleasant  spectacle.   The over-
growth of inert people who do not exercise enough
to use up a  healthy amount of over-fed tissues is
common  enough as an individual peculiarity,  but
there are also two  other conditions  in which fat is
apt to be accumulated  to an uncomfortable extent.
Thus, in  some cases of hysteria where the patient lies
abed from belief that she is unable to move about,
she is apt in time to become enormously stout.  This
seems to  me also to be favored by the large use of
morphia  to which such women are prone, so that I
should say that long rest, the hysterical constitution,
and the accompanying resort to morphia  made up a
                       2* 
18     FAT IN ITS CLINICAL RELATIONS.

group  of factors  highly  favorable  to increase of
fat.
  Lastly, there is  the  class of fat, anaemic people,
usually women.  This  double condition is not very
uncommon, but as the mass of thin-blooded persons
are as a rule thin or losing flesh, there must be some
peculiarity in that anaemia which goes with gain in
flesh.
  Bauer1 thinks that lessened number of  blood-cor-
puscles gives rise to storing of fat, owing to lessened
tissue-combustion.   At all events the absorbed oxy-
gen diminishes after bleeding, and  it used to be well
known that some people grew fat when  bled at inter-
vals.   Also, it is said  that  cattle-breeders  in  some
localities—certainly not in this country—bleed their
cattle  to  cause increase  of  fat in  the  tissues, or
of  fat secreted  as  butter  in the milk.   These ex-
planations aid us  but little  to  comprehend  what
after all  is only met with  in  certain persons, and
must therefore involve factors not common to every
one who is anaemic.  Meanwhile,  the  group of fat
anaemics is of the utmost clinical interest, as I shall
by  and by point out more distinctly.
  1 Zeitschrift fur Biol., 1872.  Phil. Med. Times, vol. iii.
page 115. 
       FAT IN ITS CLINICAL RELATIONS.    19

  There is a popular idea, which has probably passed
from  the  agriculturist into the common  mind of
the community, to the effect that human fat varies,—
that some fat is wholesome and some unwholesome,
that there are good fats and bad fats.  I  remember
well an old nurse who  assured me when I was a
student that " some fats is fast and some is fickle, but
cod-oil fat is easy squandered."
  There are more facts in favor of some such  idea
than I have place for, but as yet we have no distinct
chemical knowledge as  to whether  the fats put on
under  alcohol or morphia,  or rapidly by the use of
oils, or pathologically in fatty degenerations, or in
anaemia, vary in their constituents.   It is not at all
unlikely that such is the case, and that, for example,
the fat of  an obese anaemic person  may differ from
that of a fat and florid person.
  The flabby, relaxed state of many fat people is
possibly due not alone to peculiarities of  the fat but
also to want of  tone  and tension  in  the areolar
tissues, which, from  all that we now know of them,
may be capable of undergoing changes as marked as
those of muscles.
  That, however, animals  may take on   fat which
varies  in character is well known to breeders of cattle.
" The  art of breeding and feeding  stock," says Dr. 
20    FAT IN ITS CLINICAL RELATIONS.

Letheby,1 u is  to overcome excessive  tendency to
accumulation of either surface fat or visceral fat, and
at the same  time to produce a fat which will not
melt or boil  away in cooking.   Oily foods  have a
tendency to make soft fats which will not bear cook-
ing." Such differences are also seen between English
and American  bacon, the former  being much  more
solid; and we  know, also,  that the fat of different
animals varies remarkably, and that some, as the fat
of hay-fed horses, is readily worked off.  Such facts
as these may reasonably be held to sustain the popu-
lar creed as to  there being bad fats and good fats,
and they teach  us the lesson that  in man as in ani-
mals there may be  a difference in the value of the
fats we acquire, according as they are gained  by one
means or by another.
   I have had occasion, of late years, to watch with
interest  the  process of  somewhat  rapid  but quite
wholesome gain in flesh  in  persons subjected to the
treatment which I shall by and by describe.  Most
of these persons were treated by massage, and I have
been accustomed to question the masseur or masseuse
as to the manner in which the change takes  place.
Usually it is first seen in the face  and neck, then it
1 Letheby on Food, pp. 39, 40, 44. 
       FAT IN ITS CLINICAL  RELATIONS.     24

is noticed in the back and flanks, next in the belly,
and finally in the limbs, the legs coming last in the
order of gain, and sometimes remaining comparatively
thin long after other parts have made  remarkable
and visible gain.  These observations  have  been
checked by careful measurements, so that I am sure
of  their  correctness  for people  who fatten while at
rest in bed.  The order of increase might  be different
in people who fatten while afoot.
  Looking back over the whole subject, it will be
well for the physician to remember that increase of
fat, to be a wholesome condition, should be accom-
panied by gain in quantity and quality of blood, and
that while increase of flesh after illness is desirable,
and a good test of successful  recovery, it should
always go along with improvement in color.  Obesity
with  thin blood is one of the  most  unmanageable
conditions I know of.
  The exact relations of fatty tissue to the condition
of health are not as yet well understood; but, since on
great exertion  or prolonged  mental or moral strain
or in low fevers we lose fat rapidly, it may be  taken
for  granted that each individual should possess  a cer-
tain surplus of this  readily-lost material.  It is the
one portion of our body  which comes and goes in
large  amount.   Even thin people have  it in some 
22     FAT IN ITS  CLINICAL RELATIONS.

quantity always ready, and, despite the fluctuations,
every one has a standard share, which varies at differ-
ent times of life.   The mechanism which  limits the
storing  away of an excess is almost unknown, and
we are only aware that some foods and lack of exer-
tion favor  growth in fat, while action and  lessened
diet diminish  it; but  also we  know that while any
one can be  made to lose weight, there  are  some per-
sons who cannot  be  made to gain a pound by any
possible device, so that in this, as in other things, to
spend is easier than to get;  although it is clear that
the very thin must certainly live, so to speak, from
hand to mouth,  and  have  little  for emergencies.
Whether fat people possess greater power of resist-
ance, as against the fatal wasting of certain maladies
or not, does not seem to be known, and I fancy that
the popular medical  belief is rather opposed to  the
vital endurance of those who are unusually fat.
  At present, however, we have to do most largely
with the means of attaining that moderate  share of
stored-away fat which seems to indicate a  state of
nutritive prosperity and to be essential to those phys-
ical needs, such as protection and padding, which fat
subserves no less than to its aesthetic value, as round-
ing the curves of  the human form.
  The study of the amount of the different forms of 
       FAT IN ITS CLINICAL  RELATIONS.     23

diet which are needed by people  at rest, and by those
who are active, is valuable only  to enable us to con-
struct  dietaries  with care for masses of  men  and
where economy is an  object.   In dealing with cases
such as I shall describe it is needful usually to give
and have digested  an overplus of food, so that we
are more concerned now to know the forms of food
which thin or fatten, and  the means which  aid us to
digest temporarily an excess.
  As to quantity, it suffices to say that while  by lessen-
ing food we may easily and surely make people  lose
weight, we cannot be sure to fatten by merely  in-
creasing the amount of food given ; something more
is wanted in the way of digestives or tonics to enable
the patient to prepare and appropriate what is given,
and but too often we fail miserably in all our means
of giving capacity to assimilate food.   As I have said
before  and wish to repeat, to gain in fat  is  nearly
always to gain in blood; and I  hope to point out in
these pages some of the means by which these ends
can be  attained when  all usual  methods have  failed.
  There are, of course, a multitude of cases in which
it becomes desirable to fatten and to make blood, but
in  many of them these are easy tasks, and in some
altogether  hopeless.  Persons  who  are  recovering
healthfully from fevers, pneumonias, and other tern- 
24     FAT IN ITS  CLINICAL RELATIONS.

porary maladies, gather  flesh and make blood read-
ily, and we need only to help them by the ordinary
tonics, careful feeding,  and change of air in due
season.
  In  other and fatal or graver  maladies, in such
cases, for example, as pulmonary phthisis, however
proper it may be to fatten, it is almost an impossible
task, and, as  Pollock remarks, the lung-trouble may
be advancing even while the patient is gaining in
weight.
  There remains a class of  cases  desirable to fatten
and  redden  which are often, or  usually, chronic
in character,  and present among  them  some of  the
most  difficult problems which perplex the  physi-
cian.   If I  pause to dwell upon these, it  is  be-
cause they  are  the forms of disease  in which  my
plan of treatment has had the largest success; it is
because some of them are simply living  records of
the failure  of every  other rational and many irra-
tional plans; it  is because  many of them find no
place in the text-book, however sadly familiar they
are to the physician.
  The group I would speak of contains  that large
number of people who  are  kept  meagre  and often
also  anaemic  by constant  dyspepsia,  in  its  varied
forms, or by  those defects in  assimilative processes 
        FAT IN ITS CLINICAL RELATIONS.    25

which,  while more obscure, are as fertile parents of
similar mischiefs.  Let me add the long-continued
malarial poisonings, and we have a group of varied
origin which is a moderate percentage of cases  in
which loss of weight and of color are noticeable, and
in which the usual therapeutic methods do some-
times utterly fail.
   For  many of these, fresh  air, exercise, change  of
scene, tonics, and stimulants are alike valueless; and
for them  the concentration  of tonic  influences I
shall describe, when used with absolute rest, massage,
and electricity, are often of inestimable service.
   A portion of the last class I referred to above,
and  which I have yet  to describe, is one  I have
hinted at as the despair of the physician.   It in-
cludes that large group of women, especially, said
to have nervous exhaustion,  or who  are described
as having spinal irritation,  if that be the promi-
nent symptom.  To it I must add cases  in which,
besides  the wasting and anaemia,  emotional mani-
festations predominate,  and  which are then called
hysterical, whether or not they  exhibit ovarian or
uterine disorders.
   Nothing is more common  in practice than to see
a young woman who falls below the health-standard,
loses color and plumpness, is tired all  the time,  by
                        3 
26     FAT IN  ITS CLINICAL RELATIONS.

and by has a tender spine, and soon or late enacts
the whole varied drama of hysteria.   As one or other
set  of symptoms is  prominent she gets the appro-
priate label, and sometimes she continues to exhibit
only the single  phase  of nervous exhaustion  or of
spinal irritation.  k Far  more  often she runs  the
gauntlet of  nerve-doctors, gynaecologists,  plaster-
jackets, braces, water-treatment, and all the fantastic
variety of other cures.
  It will be worth while to linger here a little  and
more sharply delineate the classes of cases I have
just named.
  I see every week—almost every day—women who
when asked what  is the matter reply, " Oh, I have
nervous  exhaustion."   When  further  questioned,
they answer that everything tires them.  Now, it is
vain  to speak of all of these cases as hysterical, or,
as Paget has done, as mimetic.   It is quite sure  that
in the graver examples  exercise quickens the pulse
curiously, the tire shows in the  face, or sometimes
diarrhoea or nausea follows exertion,  and though
while under excitement or  in the presence of some
dominant motive  they can  do a  good deal, the ex-
haustion which ensues  is in proportion to the exercise
used.
  I have rarely seen such a case which was not more 
FAT IN ITS CLINICAL RELATIONS.    27
 or less lacking in color and which had not lost flesh;
 the exceptions being those troublesome cases of fat
 anaemic  people which I shall  by and  by speak of
 more fully.
   Perhaps a  full  sketch of one of these cases will
 be better than any list of symptoms: A woman, most
 often between twenty and thirty, undergoes a season
 of trial or encounters some  prolonged  strain.   She
 undertakes the hard task of nursing a  relative, and
 goes through  this severe duty  with the addition of
 emotional excitement, swayed  by  hopes and fears,
 and forgetful of self and of what every  one  needs in
 the way of air and food  and change when attempt-
 ing this most trying task; or possibly it is mere phys-
 ical strain, such as teaching.  In another set of cases
 an illness is the cause, and she never rallies entirely,
 or else some local uterine trouble starts the mischief,
 and although  this is cured the doctor wonders that
 his patient does not get fat and  ruddy again.
  But no matter  how it comes about, the woman
 grows  pale and thin, eats little, or if she eats does
 not profit by it.  Everything wearies her,—to sew,
to write, to read, to walk,—and by and by the sofa
or the bed is her only comfort.   Every effort is paid
for dearly, and she describes herself as aching and
sore, as sleeping ill, and as needing constant stimulus 
28     FAT IN ITS CLINICAL  RELATIONS.

and endless tonics.  Then comes the mischievous role
of bromides, opium, chloral, and  brandy.  If the
case  did not begin with uterine troubles  they soon
appear, and  are  usually treated in vain if the gen-
eral  means employed to build  up the bodily health
fail,  as in many of these cases they do fail.  The same
remark applies to the dyspepsias  and constipation
which  further  annoy  the  patient  and embarrass
the treatment.   If such a person  is emotional she
does not fail to become more so, and even the firmest
women lose self-control at last under incessant feeble-
ness.  Nor is this less true of men, and I have many
a time  seen  soldiers who  had  ridden boldly with
Sheridan or  fought  gallantly with  Grant become,
under the influence of painful nerve-wounds, as irri-
table and hysterically emotional as the veriest girl.
If no  rescue comes, the fate of women  thus dis-
ordered is at last the  bed.  They  acquire  tender
spines, and furnish the most lamentable examples of
all the strange phenomena of hysteria.
  The moral degradation which such cases undergo
is pitiable.   I have heard  a good deal of the dis-
ciplinary usefulness of sickness, and this may apply
to brief, and what I might call wholesome, maladies.
I have seen a few people who were ennobled by long
sickness, but far more often the result is to cultivate 
       FAT IN ITS CLINICAL RELATIONS.    29

self-love and selfishness and to take away by slow
degrees the  healthy  mastery which every human
being should  retain  over her own  emotions and
wants.
  There is one fatal  addition to the weight which
tends to destroy women  who suffer in  the way I
have  described.  It is the self-sacrificing love and
over-careful sympathy of a mother, a sister, or some
other devoted  relative.   Nothing is more curious,
nothing more sad and  pitiful, than  these partner-
ships between  the  sick and  selfish  and the sound
and  over-loving.  By slow  but sure degrees the
healthy life is absorbed by the sick life, in a manner
more or less injurious to  both, until, sometimes too
late for remedy, the growth  of the evil is seen by
others.  Usually the person withdrawn from whole-
some duties to minister to the caprices of hysterical
sensitiveness is  the  person of a household who feels
most for the invalid,  and who for this very reason
suffers the most.  The patient has  pain, a tender
spine, for example; she is urged to give it rest.   She
cannot read;  the self-constituted nurse reads to her.
At  last light hurts her eyes; the  mother remains
shut up with her all  day in  a darkened room.  A
draught of  air is  supposed  to  do harm, and the
doors and windows are closed, and  the  ingenuity
                       3* 
30     FAT IN ITS CLINICAL RELATIONS.

of  kindness  is  taxed to  imagine new  sources of
like trouble,  until at  last the window-cracks are
stuffed with cotton, the chimney stopped, and even
the keyhole guarded.  It  is easy to see where this
all  leads to,—the nurse falls ill, and a new victim
is found.   I have seen a hysterical, anaemic girl kill
in this  way three  generations of nurses.  If you
tell the patient  she is basely selfish she is probably
amazed, and wonders at your cruelty.  To cure such
a case you must morally alter as well as  physically
amend,  and nothing less will answer. The first step
needful  is to break up the companionship, and to sub-
stitute the firm kindness of a well-trained hired nurse.1
  Another form  of evil to be encountered  in  these
cases is  less easy to deal with.  Such an invalid has
by  unhappy chance to live with  some near relative
whose temperament is also nervous and who  is im-
patient or irritable.   Two  such people produce end-
less mischief for one  another.   In  other examples
there is  a strange incompatibility which it is difficult
to define.  The two people  who, owing to  their rela-
tionship, depend  the  one on  the other, are for some
reason  made  causelessly unhappy by their several

  l" Nurse and Patient,"  S.  Weir  Mitchell, Lippincott's
Magazine, Dec. 1872. 
       FAT IN ITS CLINICAL  RELATIONS.     31

peculiarities.   Life-long annoyance results, and  for
them there is no divorce possible.
  In a smaller number of cases,  which  have less
tendency to emotional disturbances, the phenomena
are more simple.  You have to deal with a woman
who has lost flesh and  grown colorless, but has no
hysterical tendencies.  She is merely a person hope-
lessly below the standard of health and  subject to a
host of aches and pains, without  notable organic
disease.  Wrhy such people  should  sometimes be so
hard to cure I cannot say.  But  the sad fact remains.
Iron, acids, travel,  water-cures have  for  a certain
proportion  of them no value,  or  little value,  and
they remain for years feeble and forever tired.   For
them, as for the whole class, the pleasures of life are
limited by this perpetual weariness and by the  as-
thenopia which  they rarely escape, and which, by
preventing them from  reading, leaves them free to
study day  after day their accumulating aches  and
distresses.
  Medical  opinion must, of course, vary  as to  the
causes  which give rise to the familiar cases  I have so
briefly sketched.   In fact they  vary endlessly; but
I imagine  that few physicians  placed  face to  face
with such  cases  would not feel sure  that if they
could give the patient  a liberal gain in fat and in 
 32     FAT IN ITS CLINICAL RELATIONS.

 blood they would be certain  to need very little else,
 and that the troubles of stomach, bowels, and uterus
 would speedily vanish.  Such  has certainly been the
 result of my own very ample experience.  If I suc-
 ceed  in first altering  the  moral atmosphere which
 has  been  to the  patient like the  very breathing of
 evil, and if I can add largely to the weight and fill
 the  vessels with  red  blood, I am  usually  sure of
 giving relief.  If I fail it is because I fail in these
 very points, or else because I have overlooked  or
 undervalued some serious organic tissue-change.
   If I did not know that I had been happy in thus
 aiding numberless cases in which others  had failed,
 I should not have ventured to write these pages; and
 if I have succeeded it must  be because the methods
 pursued have been other than  those now commonly
 in use.
   In the following chapters  I shall  treat of  the
 means which I have  employed, and  shall not hesi-
 tate to give such minute details as shall enable others
 to profit by my failures and successes.  In describing
 the remedies used, and the mode  of using  them  in
combination, I shall  relate a  sufficient number  of
cases  to illustrate  both the happier  results  and the
causes of occasional failure.
   The treatment I am about to describe consists in 
FAT IN ITS CLINICAL RELATIONS.    33
seclusion, certain forms of diet, rest in bed, massage
(or manipulation), and electricity; and I desire to in-
sist anew on the fact that it is the use of these means
together that is wanted.  The necessities of my sub-
ject will of course oblige me to treat of each of them
in a separate chapter. 
CHAPTER  III.
                   SECLUSION.

  It  is rare  to find any of the class of patients I
have described  so  free from  the influence of their
habitual surroundings as to  make it easy to treat
them  in their own homes.   It  is needful to disen-
tangle them from  the meshes of old habits and to
remove them from the contact with those who have
been the willing slaves  of their caprices.   I have
often  made the effort to treat  them  in  their own
homes and  to isolate them  there, but I have rarely
done so without promising  myself that I would not
again complicate my treatment  by any such embar-
rassments.  Once separate the patient from the moral
and physical surroundings which have become part
of her life  of sickness, and you will have made a
change which will be in itself beneficial, and will
enormously aid  in  the treatment which is to follow.
Of course this step is not essential in such cases as
are merely  anaemic and feeble  and thin,  owing to
distinct causes, like the exhaustion of overwork and
     34 
                   SECLUSION.                35

of long dyspepsia; but I am  now  speaking chiefly
of the large  and troublesome class of thin-blooded
emotional women, for whom a state of weak health
has become a long and almost, I might say, a cher-
ished habit.   For them there is often no  success
possible until we have broken up  the  whole daily
drama of the sick-room, with its little  selfishnesses
and  its craving for sympathy  and indulgence.  Nor
should we hesitate to insist upon this change, for not
only shall we then act in the true interests of the
patient, but we shall also confer on  those near to
her an inestimable  benefit.  A hysterical girl is, as
Wendell Holmes has said in his decisive  phrase, a
vampire who sucks the blood of the healthy people
about her; and I may add that pretty surely where
there is one hysterical girl there will be soon or late
two sick women. 
CHAPTER  IV.
                     BEST.

  I have said more than once in the early chapters
of this little volume that  the treatment I wished to
advise as of use in  a certain range of cases was
made up of rest, massage, electricity, and over-feed-
ing.   I said that the use of large  amounts of food
while at rest, more or less entire, was made possible
by the  practice of kneading the  muscles  and  by
moving them with currents able to effect this end.
I desire now to discuss in turn the  mode in which I
employ rest, massage, and electricity, and, as I have
promised, I shall take pains  to give, in regard to
these three subjects, the fullest details, because suc-
cess  in  the treatment depends, I  am sure, on the
care with which we look after a number of things
each in  itself of slight moment.
   I have no doubt  that many doctors have seen fit
at times to put their patients at  rest for  great or
small lengths  of time, but the person  who of all
others •within my knowledge used  this  means most,
      36 
                      REST.                   37

 and used it so as to obtain the best  results, was the
 late Professor Samuel Jackson.  He  was in the habit
 of  making his  patients  remain in bed  for many
 weeks at a time, and, if I recall his cases well, he used
 this treatment  in just the class of disorders among
 women which have given me the best results.  What
 these are I have been at some pains  to define, and I
 have now only to show why in such  people rest is of
 service, and what I mean  by rest, and how I apply
 it.
  In No. IV. of Dr. Seguin's  series of American
 Clinical  Lectures, I was at some pains to point out
 the value of repose in neuralgias, in  myelitis, and in
 the early stages of locomotor ataxia.   I  shall now
 confine myself chiefly to its use in the various forms
 of weakness which exist with thin blood and wasting,
 with  or without  distinct lesions of  the stomach or
 womb.
  Whether  we shall ask a patient to  walk or to take
 rest is a question which turns up for answer almost
 every  day  in practice.   Most often we  incline to
 insist on exercise, and are led to do so from a belief
 that women walk too  little, and  that to move about
a good deal every  day is good for everybody.  I
think we are as often wrong as right.   A good brisk
daily walk is for well  folks a tonic, breaks down old
                        4 
• 38
REST.
tissues, and creates a wholesome demand for food.
The same is true for some sick  people.  The habit
of horse exercise or a long walk  every day is needed
to cure or to aid in the cure of  disordered stomach
and costive bowels, but if all exertion gives rise only
to increase of trouble, to extreme sense of fatigue, to
nausea, what shall we do ?  And suppose that tonics
do not help to make exertion easy, and that the great
tonic of  change of air fails us, shall we still persist ?
And here  lies  the trouble: there are women  who
mimic fatigue,  who indulge  themselves  in  rest on
the least  pretence, who have no  symptoms so truly
honest that we  need care to  regard  them.   These
are they who spoil their own nervous  systems  as
they spoil their  children, when they have them, by
yielding  to the  least  desire and teaching them  to
dwell on little pains.   For such people there is no
help but  to insist on self-control  and on daily use of
the limbs.   They must be told to exert themselves,
and  made  to do so if that  can be.   If they are
young this is easy enough.  If they have grown  to
middle life, and made long habits of self-indulgence,
the struggle is  always useless.  But few, however,
among these women are free  from some defect  of
blood or tissue,  either original or having come on
as a result  of years of indolence  and attention  to 
REST.
39
aches and  ailments which should never have had
given to them more  than a passing thought, and
which  certainly should not have been made an ex-
cuse for the sofa or the bed.
  Sometimes the question is easy to  settle.  If you
find a woman who is in good state as to color and
flesh, and who  is always able to do what  it pleases
her to do, and who is tired by what  does not please
her, that is a woman to order out of bed and to con-
trol with a firm and  steady will.   That is a woman
who is to be made to walk, with  no regard to her
aches, and  to be made to persist until exertion ceases
to give rise to the mimicry of fatigue.   In such cases
the man who can  insure belief in his  opinions and
obedience  to his  decrees secures  very often most
brilliant and sometimes  easy success;  and it is  in
such cases that women  who are in  all other ways
capable doctors fail, because they  do not  obtain
the  needed control over those  of their  own sex.
There  are  still other cases in which the same mis-
chievous tendencies to repose, to endless tire, to hys-
terical symptoms, and to emotional displays have
grown out of defects of nutrition so distinct that no
man ought to think for  them  of mere exertion as a
6ole means of cure.  The time comes for that, but it
should not come until entire rest has  been used, with 
40
REST.
other means, to fit them for making use of their
muscles.   Nothing  upsets  these  cases like  over-
exertion, and the  attempt  to  make  them  walk
usually ends in some mischievous emotional display,
and in creating a new reason  for thinking that they
cannot walk.   As  to the two  sets  of cases just
sketched, no one need hesitate; the one must  walk,
the other should not  until we  have  bettered her
nutritive state.  She  may  be able  to drag herself
about, but no good will  be done by making her do
so.   But between these  two  classes  lies the larger
number of such cases, giving us every kind of real
and  imagined symptom,  and dreadfully well  fitted
to puzzle the most competent  physician.  As a rule,
no harm is done by rest, even in  such people as give
us doubts about whether it is or is not well for them
to exert themselves.   There  are plenty of  these
women who are just well enough to make it likely
that  if they  had motive enough for exertion to cause
them to forget themselves they would find it useful.
In the doubt I am rather given to insisting on rest,
but the rest I like for them is not at all their notion
of rest.   To  lie abed half the day, and sew a little
and read a little, and be interesting and excite sym-
pathy, is all very well, Jbut when  they are bidden to
stay  in bed a month, and neither to read, write, nor 
REST.
41
sew, and to have one nurse,—who is not a relative,
—then rest becomes for some women a rather bitter
medicine, and they are  glad  enough to accept the
order to rise and go about when the  doctor issues a
mandate which has become pleasantly welcome and
eagerly looked  for.  I do not think it easy to make
a mistake  in this matter unless  the woman takes
with  morbid delight to  the system of enforced rest,
and unless the doctor is a person  of feeble will.   I
have  never met  myself  with  any  serious trouble
about getting out of bed any woman  for  whom I
thought rest needful, but it has happened to others,
and the  man who resolves to send any nervous
woman to bed must be quite sure  that she will obey
him when the time comes for her to get up.
  I have, of course, made use of every grade of rest
for my patients,  from  insisting upon  repose  on a
lounge for  some hours a day up to entire rest in bed.
In  carrying out my general plan of treatment it  is
my habit to ask the patient to remain in bed from six
weeks to two months.  At first, and in some  cases
for four  or five weeks, I do not permit the patient
to sit up or to sew or write or read.  The only action
allowed is that  needed to clean  the teeth.  In some
instances I have  not permitted the patient to turn
over without aid, and this I have done because some-
                       4* 
42
REST.
times I think no motion desirable, and because some-
times the moral influence of absolute repose is of use.
In such cases I arrange to have the bowels and water
passed while lying down, and the patient is lifted on
to a lounge at bedtime and sponged, and then lifted
back again into the newly-made bed.   In all cases
of weakness,  treated by rest, I insist on the patient
being fed by the nurse,  and, when well enough  to
sit up in bed, I insist that the meats shall be cut up,
so as to make it easier for the patient to feed herself.
  In many cases I  allow the patient to sit up  in
order to obey the calls of nature, but I am always
careful to  have the bowels kept reasonably free from
costiveness, knowing well how such a state and the
efforts it gives rise to enfeeble a sick person.
  Usually, after a fortnight I permit the patient to
be read  to,—one to  three hours a day,—but I  am
daily amazed to see how kindly nervous and anaemic
women take to this absolute rest, and how little they
complain of its monotony.   In fact, the use of mas-
sage and the battery, with the frequent  comings  of
the nurse with food and  the  doctor's visits, seem  so
to fill up the day as to make the treatment less tire-
some than might  be supposed.   And,  besides this,
the sense of comfort which is apt to come about  the
fifth or sixth day,—the feeling of ease, and the ready 
                      REST.                   43

capacity  to  digest food, and the growing hope of
final cure, fed as it is by present relief,—all conspire
to make  most patients contented and tractable.
   The moral uses of enforced rest are readily esti-
mated.   From a restless life of irregular hours, and
probably endless drugging, from  hurtful sympathy
and over-zealous care, the patient passes to an atmos-
phere of quiet, to order and control, to the system
and care of a thorough nurse, to an absence of drugs,
and  to simple diet.   The result  is  always at first,
whatever it  may be afterwards, a sense of relief, and
a remarkable and often a quite abrupt disappearance
of many of  the nervous symptoms with which  we
are all of us only too sadly familiar.
   All the moral uses of rest and isolation and change
of habits are not  obtained by merely insisting on
the physical  conditions needed to effect these  ends.
If the physician has  the force of  character required
to secure the confidence  and respect of his patients
he has also much more in his power, and should have
the tact  to seize the proper occasions to  direct the
thoughts of his patients  to the lapse from  duties to
others, and to the selfishness which a life of invalid-
ism is apt to bring about.  Such  moral medication
belongs to the higher sphere of the  doctor's duties,
and if he means to cure his patient permanently, he 
 44                   REST.

 cannot  afford to  neglect them.  Above all, let him
 be careful that the masseuse and  the  nurse do not
 talk of the  patient's ills, and let him by  degrees
 teach the sick person how very essential it is to speak
 of her aches and  pains to no one but himself.
   I have often asked myself why rest is of  value in
 the cases of which I am now speaking, and  I  have
 already alluded briefly to some of the modes in which
 it is of  use.
   Let us take first the simpler cases.  We meet now
 and then with feeble people who are dyspeptic, and
 who find that exercise after a meal, or  indeed much
 exercise on any day, is sure to cause loss of power or
 lessened power to digest food.   The same thing is
 seen in an extreme degree in the well-known  experi-
 ment of causing a dog to run violently after eating,
 in  which  case  digestion  is  entirely  suspended.
 Whether these results be due to the calling off of
 blood from the  gastric  organs  to the muscles,  or
 whether the nervous system is, for some reason, un-
able to evolve at the same time the force needed for
 a double purpose, is not quite clear, but the fact is
 undoubted, and finds added  illustrations in many of
the class of exhausted women.  It is plain that this
trouble exists in some of them.   It is  likely that it
is present  in a larger number.  The use of rest in 
REST.                    45
these  people  admits of no question.   If we are to
give them the means in blood and flesh of carrying
on the work of life, it must be done with the aid of
the stomach, and we must humor that organ until
it  is able to act  in a  more healthy manner under
ordinary conditions.
   The muscular system in many of such patients—I
mean in ever-weary, thin, and thin-blooded persons
—is doing its work with constant difficulty.  As a
result, fatigue comes early, is extreme, and lasts long.
The demand for nutritive aid is ahead of the supply,
and before the tissues are  rebuilded a new demand
is  made,  so  that  the  materials of  disintegration
accumulate, and do this the more easily because the
eliminative organs share in the general defects.   And
these  are  some of the reasons why anaemic people
are always tired; but, besides this, all real  sensations
are magnified by women whose nervous systems have
become sensitive owing to a life of attention to their
ailments, and so at last it becomes hard to  separate
the true from the false, and we  are thus  led to be
too skeptical as to the presence of real causes of
annoyance.   Certain it is  that  rest, under proper
conditions, is found by such sufferers to be a great
relief; but rest alone will not answer, and it is need-
ful, as I shall show, to bring to our help certain other 
46
REST.
 means, in order to secure all  the good which  repose
 may be made to insure.
   In dealing with this, as with  every other medical
 means, it is well to recall that in  our attempts to
 help we  may sometimes do harm, and we must make
 sure that in causing the largest share of good we do
 the least possible evil.

   " The one goes with the other, as shadow with light,.and
 to no therapeutic measure does this apply more surely than
 to the use of rest.
   " Let us take the simplest ease,—that  which arises daily
 in the treatment of joint-troubles or broken  bones.   We
 put  the limb  in splints, and thus, for  a  time, check its
 power to  move.  The bone  knits, or the joint gets well;
 but  the muscles waste, the skin dries, the  nails may for a
 time cease to grow, nutrition is brought  down,  as an arith-
 metician would say, to its lowest terms, and when the bone
 or joint is well we have a limb which  is in a state of disease.
 As concerns broken bones, the evil may  be slight and easy
 of relief, if the surgeon will but remember that when joints
 are put at rest too  long they soon fall a  prey to a form of
 arthritis, which is  the more  apt to be severe the older the
 patient is,  and  may be easily  avoided by frequent motion of
 the joints, which, to be healthful, exact a certain share of
 daily movement.  If, indeed, with perfect  stillness of the
fragments  we could have  the full life of a limb in action, 
                        REST.                     47

I suspect that the cure of the break might be far more
rapid.
  " What is true of the part is true of the whole.   When
we put the entire body at rest we create certain evils while
doing some share of good, and it  is therefore our part to
use such means as shall, in every case, lessen and limit the
ills we cannot wholly avoid.   How to reach these ends I
shall by and by state, but for a brief space I should like to
dwell on some of the bad results which come of our efforts
to reach  through rest in bed all the good which it can give
us, and to these points I ask the most thoughtful attention,
because upon the care with which we meet and provide for
them depends the value  which we  will get out of this
most potent means of treatment.
  "When  we put  patients in bed  and forbid them  to
rise or to make  use of their  muscles, we  at once lessen
appetite, weaken digestion in  many  cases,  constipate  the
bowels, and enfeeble circulation."1

  When we put  the  muscles  at absolute rest  we
create certain  difficulties, because the normal acts of
repeated movement insure a certain rate of nutrition
which brings blood  to the  active  parts, and without
which the  currents flow more  largely  around  than
through the muscles.   The lessened  blood-supply is
1 Lecture, op. cit. 
48
REST.
 a result of diminished functional movement, and we
 need to create a constant demand in the inactive parts.
 But, besides  this, every active muscle  is practically
 a throbbing heart, squeezing its vessels empty while
 in motion, and  relaxing, so as to allow them to fill
 up anew.   Thus, both for itself  and in its relations
 to the rest of the body, its activity is functionally
 of service.  Then, also,  the  vessels,  unaided  by
 changes of posture and  by motion, lose tone, and
 the  distant local  circuits, for  all of  these  reasons,
 cease to receive their normal supply, so that defects
 of nutrition occur, and, with  these, defects  of tem-
 perature.

   " I was struck with the extent to which these evils may
 go, in the case  of  Mrs. P., set. 52,  who was brought to the
 Infirmary from New Jersey, having  been prone in bed fifteen
 years.  I soon  knew that she was free of disease, and had
 stayed in bed at first because there  was some lack  of power
and much pain on rising, and at last  because she had  the
 firm belief that she could not walk.  After a week's mass-
age I made  her get up.  I had won her full trust, and she
obeyed, or tried to obey me, like a child.  But she would
faint  and grow deadly pale, even  if seated a short time.
The heart-beats rose from sixty to one hundred and thirty,
and grew feeble;  the  breath  came  fast, and she had to lie
down  at  once.   Her skin was  dry, sallow,  and bloodless, 
                        REST.                      49

her muscles flabby; and when, at last, after a fortnight more,
I set her on  her  feet again, she had to endure for a time
the most dreadful vertigo and  alarming palpitations of the
heart, while  her  feet, in a few minutes of feeble walking,
would swell so as to present the most strange appearance.
By and by all this went away, and in a month she could
walk, sit up, sew, read, and, in a word, live like  others.
She went home a well-cured woman.
   " Let us think, then, when we put a person in bed, that
we are lessening the  heart-beats some twenty a minute,
nearly a third;  that we  are  making the  tardy blood to
linger  in  the by-ways  of the  blood-round, for it has  its
by-ways;  that rest prone binds the bowels, and  tends to
destroy the desire to eat; and that muscles  in rest too long
get to be unhealthy and shrunken in substance.  Bear these
ills in mind, and be ready to meet them, and we shall have
answered the hard question of how to help by rest without
hurt to the patient."1

   When I first  made use of this treatment I allowed
my  patients to  get  up too  suddenly,  and  in some
cases I thus brought on relapses and a  return of the

  1 Lecture, op. cit. In the July number (1876) of the Chicago
Journal of Mental and Nervous Disease is an able  review of
my lecture, in which are some criticisms which I accept as
correct, and which I have used to improve my statements of
the causes of some of the evils of rest.
                           5 
50
REST.
feeling of painful fatigue.  I  also saw in some  of
these cases what  I still see at times,—a rapid loss
of flesh.
  I  now begin by permitting the patient to sit up
in bed, then to feed herself, and next to sit up out
of bed a few minutes at  bedtime.   In a week, she
is desired to sit up fifteen minutes twice a day, and
this  is gradually increased until, at the end of twelve
weeks, she rests on the bed only three to five hours
daily.  Even after she moves about and goes out,
I insist for  two months on absolute repose at least
two or three hours daily. 
CHAPTER  V.
                     MASSAGE.

   How to deprive rest of its evils is the subject with
 which I might very well have labelled this chapter.. <
 I have pointed out what I mean by rest, how it hurts,
 and how it seems to help; and as I believe that it is
 useful in most cases only if employed in conjunction
 with other means, the study of these  becomes of the
 first importance.
   The two aids which by degrees I  learned to call
 upon with confidence to enable me to use rest with-
 out  doing  harm  are massage  and electricity.   We
 have first to deal with massage, and I willingly give
 to it a chapter of careful detail, because as yet it  is
 little understood in America,  and because  I  have
 some facts to relate  in regard to it  which are not
 known, I think, on either side of the Atlantic.
   It is many years since I first saw in this city sys-
tematic massage  used by a charlatan in a  case of
progressive  paralysis.  The temporary results he
obtained were so remarkable that I began soon  after
                                           51 
52
MASSAGE.
to learn what I could of its employment and to train
some of the nurses I had in charge of cases to make
use  of it.   Somewhat later I employed  it in the
earlier cases which I treated by rest, and  I very soon
found that  I had  in  it an .•'.gent  little understood
and  of singular utility.
   It will  be necessary, in pursuance of my plan, to
describe  exactly how  this means is  employed  and
why it is employed.
   I  can better speak of what it does after carefully
specifying the manner  of its use.
   After a few days of  the milk diet, with which my
treatment ordinarily begins, the masseur or  mas-
seuse is set to  work.  An hour  is chosen midway
between two meals, and, the patient lying in bed,
the manipulator starts at the feet and  gently but
firmly pinches up the skin, rolling it lightly between
his fingers and going  carefully over the  whole foot,
then the toes are  bent and moved about in every
direction, and next with the thumbs and fingers the
little muscles of the foot are  kneaded and pinched
more largely, and the inter-osseous groups worked at
with the finger-tips between the bones.   At last the
whole tissues of the foot are seized with both hands
and somewhat firmly rolled about.  Next the ankles
are dealt with in like  fashion, all  the crevices be- 
MASSAGE.
5.3
tween  the articulating bones being sought out and
kneaded,  while the joint is put  in  every possible
position.  The leg is  next  treated, first by surface-
pinching, and then by deeper grasping of the areolar
tissue,  and last by industrious  and deeper pinching
of the  large muscular masses, which for this purpose
are put in a position of the  utmost relaxation.   The
grasp of the muscles is momentary, and for the large
muscles of the calf and thigh both  hands act, the
one contracting as the other loosens its grip.  In treat-
ing the firm muscles in  front of the leg, the fingers are
made to roll the muscle under the cushions of the
finger-tips.  At brief intervals the manipulator seizes
the limb  in both  hands and lightly runs the grasp
upwards,  so as to favor the flow of venous blood-
currents,  and then returns  to  the kneading of the
muscles.
  The same process is  carried on in every part of the
body, and especial care is given to the muscles of the
loins and  spine, while usually the face is not touched.
The belly is first treated by pinching the skin, then by
deeply grasping and rolling the  muscular walls in the
hands, and at last the whole belly is kneaded with the
heel of the hand in a succession of rapid, deep move-
ments, passing around  in the direction of the colon.
  It depends very much on  the strength, endurance,
                        6* 
54
MASSAGE.
 and practice of the manipulator  how much good is
 done by these manoeuvres.  At  first  or  for a  few
 sittings they are to be very gentle, but by degrees
 they may be made more rough, and if the  masseur
 be a good one it is astonishing how much strength
 may be used without hurting the  patient.
   The early treatments should last half an hour  and
 should  be increased by degrees  to  one hour, after
 which should follow an hour of absolute repose.
   After the first few days I like the rubber to keep
 the  part constantly lubricated with cocoa-oil, which
 is agreeable in odor, and which keeps well  even in
 warm weather if a little lime-water  be left standing
 on the top of it.   Vaseline is also a  good  lubricant,
 and  both of these agents make the skin smooth and
 soft  and supple.
   As soon as a part has been manipulated it should
 be at once wrapped up.
   In men who are hairy it is often  needful to have
 the limbs shaved, because the constant pull made
 on the hairs gives rise to very troublesome and pain-
 ful boils.
  The early use of massage is apt in some nervous
 women to  cause increased nervousness and even loss
of sleep;  but these  symptoms may safely  be  dis-
regarded, because they pass away  in a few days, and 
                   MASSAGE.                 55

very soon  the  patient begins to find the massage
delightfully soothing and  to complain when it  is
omitted.  Women who  have a sensitive abdominal
surface or  ovarian tenderness have of course to be
handled with  care, but in a few days a practiced
rubber will by degrees intrude upon  the tender re-
gions, and will end by kneading them  with all desir-
able force.   The same  remarks apply to the  spine
when it is hurt by a touch, and it is very rare indeed
to find persons whose irritable spots cannot at last be
rubbed and kneaded to their permanent profit.
   The daily massage is  kept  up through at least six
weeks, and then, if everything seems to me to be
going along well, I direct the rubber  to spend half
of the hour in exercising the limbs as a preparation
for walking.   This is done after the  Swedish plan,
by making movements of flexion and extension,
which the patient is taught to resist.
   At the seventh  week the treatment is  used on
alternate days, and is commonly laid aside when the
patient gets up and begins to  move about.
   During  the  past year, several  of  the members
of the staff of the Infirmary for Nervous Disease, and
especially my colleague,  Dr. Wharton  Sinkler, have
obliged  me by studying with care the influence of
massage  on temperature, and as to this  some very 
56
MASSAGE.
 interesting results have been obtained.   In general,
 when we begin to rub a highly hysterical person the
 legs are apt to grow cold under the stimulation, and if
 this continues to be complained of  it is no very good
 omen of the ultimate success of the treatment.  But
 usually in a few days a change takes  place, and the
 limbs all grow warm when kneaded, as happens in
 most people  from the beginning  of  the treatment.
 The extreme low temperatures of  the limbs of chil-
 dren suffering with so-called essential  paralysis  is
 well known.   I have frequently seen these strangely
 cold parts rise, under an hour's massage, six to ten
 degrees F.   In  such small limbs, the long contact
 of a warm hand  may account for  at  least a part of
 this notable rise in temperature.
  In adults  this can hardly  be looked upon  as a
 cause of the  rise of temperature caused  by massage,
 firstly, because the  long exposure  of large surfaces
 incident to the process is calculated to lessen what-
 ever increase of  heat  the contact of the hand  may
cause, and secondly, because this rise is a very varia-
 ble quantity, and because occasionally some other and*
less  comprehensible factors actually  induce a fall
rather  than a rise in the thermometer as a result of
massage.
  In very nervous or hysterical women,  ignorant of 
                    MASSAGE.                  57

what the act of kneading may be expected to bring
about, and especially in such as are thin and anasmic,
and have either a somewhat high or an unusually low
normal temperature, we may find  at  first  a slight
fall of the thermometer, then a fairly constant rise
with some irregularities, and at last,  as the health
improves, a lessening effect or none at all.
  The most notable rise is to be found  in  persons
who, owing to  some organic disease, have a natural
liability to great changes of temperature.
  I  add a number of  tables, which very well illus-
trate the facts just stated:
  Mrs. J., at rest, on the usual diet.   Manipulation
at 11, daily.
  Before MasBage.                            After Massage.
     100      .......100
     100      .......1011
     99f.......99f
     99f.......100
     99|.......100
     100       .......100
     99f.......100
     99|.......100

  Miss P., set. 24, hysteria.
  Before Massage.                            After Massage.
     99£.......99|
     98}.......99 
58
MASSAGE.
Before Massage.                             After Massag..
     98*......."
     98£     ....•••     99
     98£.......98*
                                             991
99.......*vt
                                       100|
  's
1001.......1UU*
      lOOf.......101S
      100|.......10°l
      lOOf.......ioo

   Mrs. L., a very thin, feeble, and bloodless woman,
set. 29 years.
 Before Massage.                             After Massage.
       99.......100
       98£.......99J
       98.......98f
       99.......100
       981.....■ •    •     98|
       99     ........     99|
      100.......100£
       99.......99|

   Mrs.  P.,  set.  31,  feeble and anaemic, nervous,
slight albuminuria  and chronic bronchitis.   Liable
to fever.  3 p.m.
 Before Massage.                              After Massage.
      101|.......102
      100.......100|
       99.......99*
      100     .......    101
      991.......100* 
                     MASSAGE.                 59
•  ^^J-8 Massage.                           After Massage.
      99*.......lOOf
      1001.......1011
      1001.......991
      lOOf.......1001
      IOOtV.......100&.
       991.......991

   These temperatures were taken always before 4
p.m., and at intervals of three  days.  Her morning
temperature was  usually 99°  to  99|°, and in the
evening, 9 to 10 o'clock, it always rose  to 100, 101,
and at times to 102.
   As  I have said already, there are persons who,
under circumstances seemingly alike, have from mas-
sage a large rise of temperature, and others who ex-
perience none.  I give a single case of what is rare
but not exceptional, an almost  constant fall of tem-
perature.
   Miss N., set. 21, hysteria, good condition.
  Before Massage.                           After Massage.
      98       .......971
    .98*.......98*
      98       .......98
      981.......98
      981.......98
   As  menstruation is  sometimes in very excitable
people arrested by massage, I  usually order  the 
60                 MASSAGE.
treatment to  be given up during the flow.   In the
present case it was kept up without alteration of the
rule as to fall of temperatures.  These  facts are, of
course, extremely interesting,  but it is  well  to  add
that the success of the treatment is not  indicated in
any constant way by the thermal  changes, which are
neither so steady nor so remarkable as those caused
by electricity.
  If now we  ask ourselves why  massage does good
in cases of absolute rest, the answer—at least a  par-
tial answer—is not difficult.  The secretions of the
skin are stimulated by the  treatment of that tissue,
and it  is visibly flushed, as it ought to Joe, from time
to time by ordinary active exercise.  Under massage
the flabby muscles acquire a certain firmness, which
at first lasts only for a few  minutes, but which after
a time is more enduring, and ends by becoming  per-
manent.   The firm grasp of the manipulator's hands
stimulates  the muscle, and, if sudden, causes it to
contract sensibly.   When the patient  becomes  used
to the process, the  operator is sometimes directed to
strike  the muscular  masses with  the  soft cushion
formed by the muscles on the ulnar side of the closed
hand,  or with the same part kept in rigid extension.
The blow, if given adroitly, causes a momentary
contraction of the muscle thus struck.   The muscles 
                    MASSAGE.                 qi

are by these  means exercised without the use of vo-
lition or the  aid of the nervous centres, and at the
same time the alternate grasp and relaxation of the
manipulator's hands squeezes out the- blood  and al-
lows it to flow back anew, thus  healthfully exciting
the vessels and  increasing, mechanically, the flow of
blood to the  tissues which they feed.
   The visible results as regards  the surface  circula-
tion are sufficiently obvious, and  most remarkably
so in persons who, besides being anaemic and thin,
have been long  unused  to  exercise.   After a few
treatments the nails become pink, the veins show
where before none were to be seen, the larger vessels
grow fuller, and the whole tint of the limbs changes
for the better.
   In like manner the sore places, which either ex-
isted  before  or are  brought into sensitive promi-
nence  by the manipulation,  by  degrees cease  to be
felt, and  a general  sensation of comfort and ease
follows the later treatments.
   I am accustomed to pay a  good deal of attention
to the observations made as to these and other points
by practiced manipulators, and I find that their daily
familiarity with every detail  of the color and firm-
ness of the tissues is often of  great use to me.
6 
CHAPTER  VI.
                  ELECTRICITY.

  Electricity is the second means which I have
made use of for the purpose of exercising muscles in
persons at rest.   It has also an additional value, of
which I shall presently speak.
  In order to exercise the muscles best and with the
least amount of pain and annoyance, we make use
of an induction current, with  interruptions as slow
as one in every two to five  seconds, a rate  readily
obtained in properly-constructed  batteries.    This
plan is  sure to give painless exercise, but  it is less
rapid and less  complete as to the quality of  the ex-
ercise caused than the movements  evolved by very
rapid interruptions.  These, in the hands of a clever
operator who knows his anatomy well, are therefore,
on  the  whole,  more satisfactory, but they  require
some experience to manage them so as not to shock
and disgust the patient by inflicting needless  pain.
The poles, covered with well-wetted sponges, which
I prefer to chamois or other  thin covers, are placed
      62 
ELECTRICITY.
63
on each muscle in turn, and kept about  four inches
apart.  They are moved  fast enough to allow of
the  muscles being well contracted, which is easily
managed, and with  sufficient speed if the assistant
be thoroughly acquainted with the  points of  Ziems-
sen.  After the legs are treated the muscles of the
belly and  back  and  loins are gone over system-
atically,  and finally those of  the  chest and arms.
The face and neck are neglected.   About forty min-
utes to an  hour are needed;  but at first a less time
is employed.  The general result  is to  exercise in
turn all the external muscles.
   No such obvious  and visible results are seen as
we observe after  massage, but the thermal changes
are much more constant and remarkable, and show
at least that we are not dealing with an agent which
merely amuses the  patient or acts alone through
some mysterious influence on the mental status.
   A half-hour's treatment of the muscles commonly
gives rise  to a  marked elevation  of temperature,
which fades away within an  hour or two.   This
effect is,  like  that from massage, most  notable  in
persons liable to fever from some  organic trouble,
and it varies as to its degree in individuals who have
no such disease.
  The first case, Miss B., aet. 20, is an example  of 
64
ELECTRICITY.
tubercular disease of  the apex of  the right lung.
She had a morning temperature of 98J to  99J, and
an evening temperature of 100 to 102.
  Electricity was used about 11 o'clock daily, with
these results:
                          Before Electricity. After Electricity.
November 25		. 99	991
k	27 .	. . 97-|	100
t<	28 .	. 98	99
CI	29 .	. . 981	991
Decemb<	sr 2 .	. . 1001	1011
i<	4 .	• • 991	1001
(i	5 .	. . 991	991
  Mrs. R., aet. 40, the next case, was merely a rather
anaemic, feeble, and thin woman, who for years had
not been able to endure any prolonged  effort.  She
got well under the general treatment, gaining thirteen
pounds on  a weight of ninety-eight pounds,  her
height being five feet and one inch.   The facts as to
rise of temperature are most remarkable, and I need
not say were carefully  observed, the observations
being made  by Dr. Sinkler.
  Temperature taken in the mouth while at rest in bed.
April  2
  "   3
  "   4
Before Electricity. After Electricity.
               98*
98|      98|
 J3
981
 J5
981 
ELECTRICITY.
65
		Before Electricity.	After Electricity.
April	L 5	. 98	981
u	6 .	Q7 9 • y/T0-	98A
(i	7 .	. 98	98A
it	8 .	. 98	981
(i	9 .	. 98	99TV
i<	10 .	. 981	981
CI	11 .	, . 98TV	98^
II	12 .	• 981	99r5
II	13 .	• 981	99A
II	14 .	• 981	991
II	16 .	• 98^	99^
II	17 .	. 98^	99T2ff
II	18 .	. 98^	99TV
(1	19 .	. 98T'ff	99T%
II	20 .	. 99	99^
II	21 .	• 98&	99T%
		Menstrual period.	
II	30 .	. 981	981
May 1 .		. 98	98T%
u	2 .	. 98	98T3o
   The third case, Miss M., aet. 33, was that of a
pallid woman, the daughter of a well-known physi-
cian.   She  suffered for six  years with "nervous
exhaustion," headaches, pain in the back, intense
depression of spirits, nausea, and repeated attacks of
hysteria.  She slept only under anodynes, and used
stimulants  freely.   Under  the use of rest and the
adjuvant treatment described, Miss M. made a thor-
                        6*
one hour later, 99^
 u   u   «i  984 
66
ELECTRICITY.
ough recovery, and was restored to  useful, active
life.
  Miss M.   Thermometer held in mouth five  min-
utes before and after treatment.

       Before Electricity. After Electricity.
May 14    .  99^      99^ 1 Menstruating; general faradi-
     15    .  99        99± I   zation only.
     16    .  991       991  Gen'l faradization and limbs.
     17    .981       991
     18    .  981       99i
     19    .  981       981
     21    .  981       99
     22    .  981       99A
     25    .  98TV      98T\
     26    .  98TV      99TV
     29    .  981       99
     30    .  98^      99TV
     31    .  98&      99TV

  Mrs. P., aet. 38, was a  rather  nervous  woman,
easily tired, but not anaemic and not very thin.   She
improved greatly under  the treatment.
  Mrs. P.  General tonic treatment.
          Before Electricity. After Electricity.
January 27	■ 981	991	Thermometer in axilla ten
" 29	. 981	99i	minutes before and after.
" 30	■ 991	991	
" 31	• 981	991	
February 1	. 99	991	
 
ELECTRICITY.
67
           Menstrual period.
Before Electricity. After Electricity.
February 8		. 981	991	
	9	• 981	99	
	10	. 981	99	
	12	. 981	991	
	13	• 981	99	
	14	• 981	98f	
	15	• 981	981	
	19	. 99	981	
	20	. 98	99	-
	23	• 981	991	Thermometer in mouth five
	24	. 99	991	minutes before and after.
	27	• 991	991	
	28	• 981	99f	
		Menstrual		period.
March	13	. 99	991	
u	14	. 981	981	
u	15	. 99	991	
   Miss R., set. 27, was a fair case of hysterical  con-
ditions; overuse of chloral and bromides; anorexia
and loss of flesh and color.
   Thermometer held in mouth five minutes before
and after treatment.
Before Electricity. After Electricity.
May 15	100	100
» 16	100	100
u !7	1001	100f
" 18	981	981
« 19	991	100Ti
1
}
General faradization for fif-
  teen minutes.

Gen'l faradization and arm
  muscles twenty minutes. 
68
ELECTRICITY.
Before Electricity. After Electricity.
May 20	100^	100	General faradization, ten
" 22	991	991	minutes ; arms and legs,
" 26	99A	99T%	twenty minutes.
" 27	9»A	99A	
" 28	991	991	
" 29	99&	99TV	
" 30	99TV	99^	
« 31	99TV	QQ 2	
June 2	991	991	
u 4	99^	99T%	
» 6	99to-	99^	
" 7	• 99A	99A	
  I have given these full details because I have not
seen elsewhere any statement of the rather remark-
able phenomena which they exemplify.  It may be
that a part at least of the thermal change is due to the
muscular action, although this seems hardly compe-
tent to account for any large share in the alteration
of temperature, and we must look further to explain
it fully.  No mental excitement can be called upon
as a cause, since it continues after  the patient  is
perfectly accustomed to  the process.   I should add,
also, that in most cases the subject of the experiment
was kept in ignorance of the fact that a rise of the
thermometer was to be expected.   Is it not possible
that the current even of an induction battery has the
power so to stimulate the tissues as to cause an in- 
ELECTRICITY.
69
crease in the ordinary rate of disintegrative change?
Perhaps a careful study of the secretions might lend
force to this suggestion.  That the muscular action
produced  by the battery is not essential to cause in-
crease of the bodily heat is shown by the next set of
facts to which I desire to call attention.
   Some years ago Messrs. Beard and Rockwell stated
that when an induced current is used for fifteen to
thirty minutes daily, one pole on the neck and one
on either foot, or alternately on both, the  persistent
use of this form of treatment was decidedly tonic in
its influence.   I believe that in  this opinion they
were perfectly correct, and  I am now able to show
at least that, thus employed, the induced  current
causes also  a decided rise of temperature in many
people, which proves at least that it is in some way
an active agent, capable of positively influencing the
nutritive changes of the body.
   The  rise of temperature thus caused is less con-
stant, as well as less marked, than that  caused by
the muscle  treatment.  I do not  think it necessary
to give the  tables in full.   They show in  the best
cases rises of one-fifth to four-fifths of a degree F.,
and were taken with the very utmost care, to exclude
all possible causes of error.
   The mode of treatment is as follows: At the close 
70
ELECTRICITY.
of the muscle electrization one pole is placed on the
nape of the neck and one on a foot for fifteen min-
utes.   Then  the foot  pole is  shifted to  the other
foot and left  for a like length of time.
  The primary current is used as being  less painful,
and the interruptions are made as rapid as possible,
while the control wires or cylinder are adjusted so
as to give a current which is not uncomfortable. 
CHAPTER  VII.
         DIETETICS AND THEKAPEUTICS.

  The somewhat wearisome  and minute  details  I
have given as to Seclusion, Rest, Massage, and Elec-
tricity, have  prepared  the way  for  a discussion of
the dietetic and medicinal treatment which without
them would be neither possible nor useful.
  As to diet, we have  to be guided  by the previous
condition and history of the patient.
  Very rarely these women are good  feeders,  and
those who are,  seem apt to be—in a few cases—fat
as well as  anaemic.   As to this latter class, it  is
needful to say something before we consider the
larger  group.  I have sought to treat fat anaemic
cases  by the use of massage, electricity,  iron,  and
rest, but this does not  answer so well as another
plan, which at  first sight may seem somewhat start-
ling.   After putting the patients at absolute rest in
bed I place them on a diet of skimmed milk, which
is kept at such an amount as will thin the woman  at
a rate  that will cost her  about  half a  pound daily.
                                          71 
72      DIETETICS AND  THERAPEUTICS.

If she were afoot this falling off would be  severely
felt, but when abed it is amazing how little annoy-
ance it causes.
  As  to the  detail of treatment, it  is as  follows:
The rest is made absolute, as to which I have already
spoken.   Then  I give daily  about  two quarts of
milk,  well  skimmed.  It is used as Carel  directs,
cold  or  warm, not hot,  and the amount given  is
divided  so  that  the  patient  takes every two hours
enough to make up the full share during the waking
day.   In my hospital wards we weigh the patient
every day, and the milk is slowly reduced  until the
loss of weight becomes perceptible.   "When a woman
weighing one hundred pounds is lying in bed, and
does nothing, about three pints of skimmed  milk
daily  will usually sustain  her weight without  other
nourishment;  but as to this  there are,  of course,
individual peculiarities.  M. C, aet. 22, a very ner-
vous person, with some dyspepsia, was thus fed, and
for  ten  days  did not vary more than a few ounces
from day to day.
  I saw lately a lady from New  York, who, having
been  dyspeptic, was placed  on  milk  diet,  and for
two years lived a moderately active life afoot on two
quarts of milk per diem.  She  consulted me as  to
the method of escaping from the tiresome monotony 
        DIETETICS AND  THERAPEUTICS.      73

of this diet.  As I observed that while exercising she
was unable to digest other food without pain, I put
her at rest and used massage and electricity.  After
a time I treated her as I would  have done  a child
who had to  be rapidly weaned,  and was  thus  suc-
cessful by a series of changes in diet in enabling her
to increase to a sufficient and comfortable extent the
range of her dietary.
   When using  milk  as  a restricted  diet  in cases
of  fat anaemia, it is sometimes necessary to substi-
tute beef-soup  for  a day on account of the disgust
which milk may occasion.
   Early this spring,  Mrs. C, aet. 40, came under
my care with partial hysterical paralysis of the right
and hemi-anaesthesia of the  left  side.   She  had no
power to feel pain or to distinguish heat from cold,
but touch  was perfect.   The  long  strain of great
moral  suffering  had left her in  this state, and  ren-
dered her  somewhat emotional.   Her appetite was
fair, but she  was strangely white, and weighed one
hundred and sixty-three pounds, with a height of
five feet five  inches.  As she had had  endless treat-
ment by iron, change of air, and  the like,  I  did not
care to repeat what had already failed.-  She  was
therefore put at rest in bed, and  treated with milk,
slowly lessened in amount.  Her stomach-troubles,
                        7 
74      DIETETICS AND  THERAPEUTICS.
which had been very annoying, at once disappeared,
and when the milk fell to three  pints she began to
lose flesh.  With  a  quart of milk  a day she  lost
half a pound daily, and  in  two weeks  her  weight
fell to one hundred and  forty  pounds.   She  was
then placed  on  the  full  treatment, which I shall
hereafter  describe.   The  weight  returned slowly,
and with it she became quite ruddy, while her flesh
lost altogether its  flabby character.  I never saw a
more striking or more instructive result.
  I have been careful to speak at length of these fat
anaemic cases because, while rare, they have been, to
me, at least,  among the most difficult to manage of
all the curable anaemias, and because with the plan
described I have been almost as successful as I could
desire.
  The use of milk makes nearly always  an essential
part of my early treatment of the mass of my cases.
I mean of those who are thin and anaemic.
  Let us  suppose that  we have  carefully studied a
case and decided that we have to deal with a person
who is thin-blooded, feeble, and lacks flesh.   Let us
make sure that there is no grave uterine or other
malady, no renal or pulmonary disease, nothing worse
than constant dyspepsia and the numberless aches
and tires which characterize these patients.  We sep- 
        DIETETICS  AND THERAPEUTICS.      75

arate  the woman from her friends, and we put her
at entire rest in bed.
   The next step  is to get her by degrees on a milk
diet, which has two advantages.   It enables us  to
know precisely the amount of food taken, and  to
regulate  it easily; and it nearly always dismisses, as
by magic, all the dyspeptic conditions.   If the case
be an old one I rarely omit the milk; but, although I
begin with three ounces every two hours, I increase
it in  a  few days  up  to two quarts, given in divided
doses every three hours.   If a cup of coffee given
without  sugar  on awaking does  not regulate the
bowels, I add a small amount of watery extract of
aloes at bedtime;  or if the constipation be obstinate,
I give thrice a day one quarter of a grain of ex. aloes
with two grains of dried ox-gall.   I find the simple
milk diet a great aid towards getting rid of chloral,
bromides, and morphia, all  of which I usually am
able to lay aside during the first week of treatment.
Nor is it less easy with the same means to enable
the patient to give up stimulus, and I may add that
in the congested stomach of the habitual hard drinker
the milk treatment is  of admirable  efficacy.   As I
have  spoken over and over of the use of stimulus
by nervous women, I should be careful to explain
that anything like great excess on the part of women 
76      DIETETICS AND THERAPEUTICS.

of the upper classes is, in my opinion, extremely rare,
and that when I speak of the habit of stimulation I
mean only that nervous women are apt to be taught
to take wine or whisky daily, to an extent that does
not affect visibly their appearance or demeanor.
  Meanwhile  the  mechanical  treatment  is steadily
pursued, and in four days to a week, when the stom-
ach has become comfortable, I  order the  patient to
take also a light breakfast.   In  a  day  or  two she is
given a mutton-chop as a midday dinner, and in a
day  or two  more she has added bread and  butter
thrice a day; within ten days I am  commonly able
to allow three  full meals daily, as well as three or
four pints of  milk,  which are given  at  and after
meals, in place of water.
  Within ten days I  order also two ounces of fluid
malt  extract before  each meal.   I  have tried  all
the extracts, but I prefer the imported Hoff's fluid
malt.
  No troublesome symptoms usually result from this
full  feeding, and the patient is made to eat  more
largely by being fed  by her attendant.  People who
will eat very little if they feed themselves, often take
a large amount when fed by another, and, as I have
said before, nothing is more tiresome than for a patient
flat on her back to cut up her food, and to use the fork 
        DIETETICS AND  THERAPEUTICS.      77

or  spoon.   By  the  plan of feeding we thus gain
doubly.
   As to the meals,  I leave them to the patient's ca-
price, unless this is  too unreasonable; but I like to
give butter  largely, and as it is with us very good, I
have little  trouble in  getting this most wholesome
fat taken in large amounts.
   At the close of  the first week  I like  to  add one
pound of beef,  in the form of raw soup.  This is
made by chopping up one pound of raw beef, placing
it in a bottle with one pint of water and five drops of
strong chlorohydric acid.  This mixture stands on ice
all  night, and in the morning the bottle is set in a pan
of water at 110° F., and kept two hours at about this
temperature.  It is then thrown on to a stout cloth
and strained until  the mass which remains is nearly
dry.  The filtrate is given in three portions daily.  If
the raw taste prove very objectionable, the beef to be
used is quickly roasted on one side, and then the pro-
cess is completed in the manner above described. The
soup thus made is for the most part raw, but has also
the flavor of cooked meat.
  In difficult cases,  especially those treated in cool
weather, I  sometimes  add, at  the third week, one
half-ounce of cod-liver oil, given half an hour after
each meal.   If  it lessens the  appetite,  or causes
                        7* 
78      DIETETICS AND  THERAPEUTICS.
nausea, I use it thrice a day as a rectal injection ; and
in cases where the large doses  of iron  used cause
intense constipation, I find the use of cod-oil cnemata
doubly valuable, by acting as a  nutriment and by
disposing the bowels to act daily.  When  given thus,
I like to use it in  emulsion, with the juice  drained
off after crushing  the fresh pancreas of the beef in
warm water.  Enough water to  cover a  half-pound
of chopped pancreas is allowed to stand for an hour
in a warm  kitchen, and then squeezed  through  a
towel.   An  ounce  is mixed with half that amount of
oil and injected slowly thrice a day. This suits some
people well, and may result in a single passage daily,
but in  others it is  annoying, and  is either badly re-
tained  or not at  all, and sometimes  gives  rise to
tenesmus.
   The question of  stimulus is a grave one.   In  too
many cases  which  come  to me, I have  to  give so
much care to break off the use of all forms of alco-
holic drinks that I  am loath to resort to them in any
case, although I am satisfied that a small amount is
a help  towards speedy increase of fat.  It is, there-
fore, a  matter for careful judgment, and  in  persons
who have never used it  in excess, or as a habit, I
prefer to give, with the other treatment, a small daily
ration of stimulus; an ounce a day  of  whisky  or 
        DIETETICS AND THERAPEUTICS.     79

two or three glasses of dry champagne, have seemed
to  me useful as adjuvants,  and as increasing the
capacity to take food  at  meals.  Nevertheless,  alco-
hol is not essential  in these cases, and, for  the  most
part, I give none, except the small amount found in
malt extracts.
   So soon  as my patient  begins to take other food
than milk, and sometimes even before this,  I like to
give iron;  but I have not much faith in the  grain
doses of iron in common use, and, after many trials,
I find that the old subcarbonate of iron of the United
States  Pharmacopoeia answers every purpose, and
has the advantages, for  hospital use, of cheapness,
and of being not unpalatable.
   I order  two ounces of the powder to be put in
one quart of distilled water.  This is well shaken,
and two ounces poured into a half-tumbler  of water,
or  carbonated water,  or apollinaris  water.  This is
drunk at each meal, and, in some cases, four or five
times a day.
   Very often I meet  with women who cannot  take
iron, either because it disturbs the  stomach,  causes
headache, or constipates, or else  because Dr. Blank
has told them never to take iron. In the latter case
I simply add five grains of pyrophosphate to  each
ounce of malt, and give it thus for a month unknown 
80      DIETETICS AND THERAPEUTICS.

to the patient.  It is then easy to  make clear  to
them that iron is  not so difficult to take as they
had been led to believe, and when it has ceased  to
disagree mentally, I find that I am able to fall back
on the coarser method.   If  iron constipates, as it
may and  does often do when used  in these large
doses, the trouble  is corrected by the  pill of  aq. ex.
aloes and  gall already mentioned, or by the enemata
of oil.  The instances in which iron gives headache
and sense of fulness  are very rare when  the patient
is undergoing the full treatment described, and, as a
rule, I disregard all such complaints, and find that
after a time I cease to hear anything  more of the
symptoms alluded to.  Of late  I have also used
with increasing satisfaction dialyzed oxide of iron.1
It does not color  the teeth, and I do not think it
constipates as much as the  subcarbonate, and many
of my patients think it suits  them better than any
other form of iron.   I give it four times a day, in
doses of six to nine grains.
  Unless  some especial need arises,  iron, in some
form, is the only drug I care to use  in  these cases
until the patient begins to sit up, when I give nearly
  1 This is now admirably made, on a large scale, by Wyeth
& Co., of Philadelphia. 
         DIETETICS  AND THERAPEUTICS.      81

 always  the  thirtieth of a grain of  strych. sulph.
 thrice a day.
   Probably  no  physician will read  the account I
 have here detailed of the vast amount of food which
 I am enabled to give, not only with impunity from
 dyspepsia, but with lasting advantage, without some
 sense of wonder; and, for my own part,  I can only
 say that I have watched again and again,  with grow-
 ing  surprise,  some  listless,  feeble,  white-blooded
 creature learning by degrees to consume  these large
 rations,  and gathering under their use flesh, color,
 and wholesomeness of mind and body.   It is need-
 less  to say that it is not in all  cases easy to carry out
 this treatment.
   When the  full treatment has been reached, and
 kept up for a few days, I begin to watch the urine
 with care, because, if  the patient be over-fed,  the
 renal secretion speedily  betrays this  result  in  the
 precipitation  of urates.  When this  occurs  at all
 steadily, I usually give directions to lessen the amount
 of nitrogenous food  until  the urine  is  again  free
 from sediment.
   Nearly always at some time in the progress of  the
case  there are attacks of dyspepsia, when it suffices
to cut down the diet one-half, or to give  milk alone
for a day or two.  Diarrhoea is more  rare, and has 
82      DIETETICS AND  THERAPEUTICS.

to be met  in like manner;  or, if obstinate, it may
be requisite to give the milk boiled.   Occasionally
the rapid increase of blood is shown by nasal  hem-
orrhage, which needs no especial treatment.
  Perhaps  I shall make myself more clear if I now
relate in full the diet-list of some of my cases, and
the mode of arranging it.
  I take the following case  as an illustration  from
my note-book:
  Mrs. C,  a New England woman, undertook, at the
age of sixteen, a severe course of study, and in two
years completed  the  whole range of studies, which,
at the school she  went to,  were usually spread over
four years.  An early marriage;  three pregnancies,
the last two of  which broke in upon the  year of
nursing; began at last to  show in loss of flesh and
color.  Meanwhile she met with  energy the multi-
plied claims of  a life full of sympathy for every
form  of trouble, and, neglecting none of the duties
of society or kinship, she yet found time for study
and accomplishments.  By and by she began to feel
tired, and at last gave way quite abruptly, ceased to
menstruate  five years before I saw her, grew pale
and  feeble, and  dropped in weight in six  months
from one hundred and twenty-five pounds to ninety-
five.  Nature had at  last  its revenge.  Everything 
        DIETETICS A ND  THERAPE UTICS.      83

 wearied her: to eat, to drive, to read, to sew.  Walk-
 ing  became impossible,  and, tied to  her  couch,
 she  grew  dyspeptic and constipated.   The  asthe-
 nopia which is almost constantly seen in such cases
 added to  her trials, because reading had to be aban-
 doned, and so at last, despite unusual vigor of char-
 acter, she gave way to utter despair, and became at
 times emotional and morbid in her views of  life.
 After numberless forms of treatment had been used in
 vain, she came to this city and passed into my care.
   At this time she could not walk more than a few
 steps without flushing and without a sense of painful
 tire.  Her temperature was 97°.5 F., and her white
 corpuscles were perhaps a third too numerous.  After
 most careful examination I could find no disease of
 any  one organ, and I  therefore  advised  a resort to
 the treatment with full confidence in the  result.
   In this single case I give  the schedule of diet in
 full as a fair example:
   October 10.—Mrs. C. remained  in bed at entire
 rest.  She was fed, and rose only for the purpose of
 relieving the bladder or the rectum.
   10.—Took one  quart  of milk in  divided  doses
every two hours.
   11.—A cup of coffee on rising, and two quarts of
milk given in divided portions every two hours.   A 
84      DIETETICS AND  THERAPEUTICS.

pill of aloes  every night, which answered for a few
days.
  12  to  15.—Same  diet.   The dyspepsia by  this
time was relieved, and she slept without her habitual
dose of chloral.  The pint of raw soup was  added
in three portions on the 16th.
  17 and 18.—Same diet.
  19.—She took, on awaking at 7, coffee; at 7.30,
half-pint of milk; and the same at 10 a.m.,  12 m.,
2, 4, 6, 8, and 10 p.m.   The soup at 11, 5, and 9.
  23.—She took for breakfast an egg and bread  and
butter;  and two days later (25th) dinner was added,
and the iron.
  On the 28th this was the schedule :
  On waking, coffee  at 7.   At 8, iron and malt.
Breakfast,  a  chop,  bread  and butter;  of milk, a
tumbler and a half.   At 11, soup.   At 2, iron  and
malt.   Dinner, closing with milk, one or two tum-
blers.   The dinner consisted of anything she liked,
and with it she took about six ounces of burgundy
or dry champagne.  At 4, soup.  At 7, malt, iron,
bread and butter, and  usually some fruit, and com-
monly two glasses of milk.   At 9, soup; and  at 10
her  aloe  pill.   At 12 m., massage occupied an hour.
At  4.30  p.m. electricity was  used  for an  hour in
the manner which I have described. 
DIETETICS AND  THERAPEUTICS.
   This heavy diet-list, reached in a few days by a
 woman who had been unable to digest with comfort
 the  lightest meal,  seemed certainly surprising.    I
 have not given in full the  amount eaten at meal-
 time.  Small  at first, it was increased rapidly by  the
 patient's growing desire for  food, and became in  a
 few days three full meals.
   It is necessary to  see the result in one of these
 successful  cases  in order to  credit  it.    Mrs. C
 began to show gain  in flesh about the face in  the
 second week of treatment, and during her two months
 in bed rose in weight from ninety-six pounds  to  one
 hundred and  thirty-six; nor was  the gain in  color
 less  marked.
   At the sixth  week  of  treatment the  soup  was
 dropped, wine abandoned, the iron lessened one-half,
 the  massage and electricity used  on alternate days,
 and  the  limbs exercised as I have described.  The
 usual precautions  as  to rising and exercise  were
 carefully attended to, and at the ninth week of treat-
 ment my patient took a drive.  At this time  all
 mechanical treatment ceased, the  milk  was reduced
 to a  quart, the iron to five grains thrice a day, and
 the malt continued.   At the sixth week I began to
employ strychnia in doses of  one-thirtieth of a grain
thrice a day at meals, and this  was kept up for sev-
                        8 
86      DIETETICS AND  THERAPEUTICS.

eral months, together with the iron and malt.   The
cure was complete and permanent, and its character
may be tested  by the fact that at the thirtieth day of
rest in  bed, and  after five years of failure to men-
struate, to her surprise  she  menstruated, and  con-
tinued to do so with regularity until eighteen months
later, when she  became  pregnant.  The only draw-
back  to her perfect use of all  her functions lay in
asthenopia, which persisted nearly a year after she
left my care.  Fatigue of vision for near work is a
common condition of the cases I am now describing,
and it is apt to persist long  after  all other troubles
have  vanished.    When there  is  no  asthenopia I
usually think  well of the general chance of recovery;
but in  no case of feeble vision do I  omit to have
the optical apparatus of  the  eye looked at with care,
because pure  asthenopia, apart  from  all optical de-
fects, is a somewhat rare symptom.
   In thus stating the schedule of diet and treatment
I do not wish it to be considered as applicable to all
cases.  There are rare, very rare, cases in which milk
agrees best between meals.   There are  cases, still
more rare, in  which no milk  can be taken under any
circumstances.  There are others in which cod-liver
oil is  known to agree so well that it can be given in
unusual doses. 
DIETETICS AND THERAPEUTICS.      87
  As additional illustrations I shall now state a few
cases, and I  shall not enter into  minute details of
treatment.
  Miss C, an interesting woman,  set. 26, at the age
of 20 passed through a grave trial in the shape of
nursing her mother through a typhoid fever.   Soon
after, a series of calamities deprived her of fortune,
and she became, for support, a clerk, and did for two
years eight hours of work daily.   Under these suc-
cessive strains her naturally sturdy health gave way.
First came the pain in the back, then  growing pale-
ness, loss of flesh, and unending sense of tire.   Her
work, which was a necessity, was  of course kept up,
steadily at first, but was soon interrupted by increase
 of the menstrual flow, with unusual pain and persist-
 ent ovarian  tenderness.  Very soon she began to drop
 her work  for a day at a time.   Then came  an in-
 creasing asthenopia  with evening headaches, until
 her temper changed and became  capricious and irri-
 table.   When  I  saw her she had been  forced  to
 abandon all labor  and had been treated by  an ac-
 complished gynaecologist, and was said to be cured of
 a prolapsus uteri and of extensive ulceration, despite
 which relief she gained nothing in  vigor  and en-
 durance, and got back neither color nor flesh.
    She went to bed December 10 and rose for the first 
88      DIETETICS AND THERAPEUTICS.

time February 4, having  gained twenty-nine pounds.
She went to bed pale and got up actually ruddy.  In
a month she returned to her work again, and has
remained ever since in health which enables her, as
she writes me, " to enjoy work, and to do with myself
what I like."
  Two years ago Miss L., aet.  26, came to me with
the following history: At the  age of 20 she  had a
fall,  and began in a week or two to have an irritable
spine. Then, after a few months, a physician advised
rest, to which she took only too kindly, and in a year
from the time of her accident she was rarelyout of bed.
Surrounded by highly sympathetic relatives, to whom
chronic  illness was somewhat novel, she speedily  de-
veloped with  their tender aid hyperaesthetic  states
of the eye and ear, so that her nurses crept about in
a darkened room, the piano was silenced, and  the
children kept quiet.  By slow degrees a whole house-
hold passed under the selfish despotism of a hysterical
girl.  Intense constipation,  anorexia, and  alternate
states of dysuria, aneuria, and polyuria followed, and
before long her sister began to fail  in health, owing
to the incessant exactions to which she too willingly
yielded.  This alarmed a brother, who insisted upon
a change of treatment, and after some  months  she
was brought on a couch to this city. 
        DIETETICS AND THERAPEUTICS.      89

  At the time I first saw her she took thirty grains
of chloral every night and three hypodermic injec-
tions of one-half grain  of morphia daily.   As  to
food, she took next to none, and I could only guess
her weight  at  about  ninety pounds.    She was  in
height  five  feet two and a half inches,  and very
sallow, with pale lips, and the large, indented tongue
of anaemia.  I made the most careful search for signs
of organic mischief, and finding  none, I began my
treatment as usual with milk, and added massage and
electricity without waiting.  Her digestion seemed so
good that I gave the iron in twenty-grain doses from
the third day, and also the aloe extract pill thrice a
day.  It is perhaps needless to state that I isolated
her with a nurse she had never seen before, and that
for  seven weeks she saw no one else save myself and
the attendants.   The  full schedule  of diet  was
reached at the end of a fortnight, and the chloral
and morphia were given up at the second day.  She
slept well the fourth night, and, save twice a slight
return  of polyuria, she  went  on without a single
drawback.   In two   months  she was afoot  and
weighed one hundred and twenty-one pounds. Her
change in tint, flesh, and expression were so remark-
able that the process of repair  might well have been
called a renewal of life.
                        8* 
90     DIETETICS AND THERAPEUTICS.

   She went home changed  no  less morally  than
physically, and  resumed her place in the  family
circle and  in social life, a  healthy and well-cured
woman.
   I might multiply these histories almost endlessly.
In some cases I have cured without fattening;  in
others,  though  rarely,  the mental habits formed
through  years of illness have been too deeply in-
grained for change, and I have seen the patient get
up fat  and  well  only to relapse  on  some slight
occasion.
   The intense persistency with which some women
study and dwell upon their symptoms  is often the
great difficulty.   Even a slight physical annoyance
becomes  for one  of these  unhappily constituted
natures  a  grave and almost ineradicable trouble,
owing to the habit of self-study.
   Miss  P., aet. 29, weight one hundred and  eleven
pounds, height five  feet  four inches, dark-skinned,
sallow, and covered with the acne of bromidism,
consulted me  last year.   She had  had one  attack
which some one considered to have been epileptic,
and which  was probably hysterical,  but on  this
matter she dwelt with incessant  terror, which was
fostered by the tender care of a near relative, who left
her neither by night nor day.  Vague neuralgic aches 
        DIETETICS AND  THERAPEUTICS.      91

in the  limbs,  with constant  weariness, asthenopia,
anaemia, loss of appetite, and  loss of flesh, followed.
Then came spinal pain and irregular menstruation,
a long  course of local  cauterizations of the womb,
spinal braces, and endless tonics and narcotics.
  I broke up the association which had nearly been
fatal  to both women, and,  confidently  promising a
cure,  carried out my treatment  in full.   In three
months she  went  home  well and  happy,  greatly
improved in looks, her  skin clear, her  functions
regular, and weighing  one  hundred and thirty-six
pounds.
  It is vain to  repeat the relation of such cases,  and
impossible to put on paper the means for deciding—
what  is so large a part of  success in treatment—the
moral methods of obtaining confidence and insuring
a childlike acquiescence in every needed measure.
  Another class  of cases  will, however, bear some
further illustration.  We meet with women who are
healthy in mind, but who have  some chronic pain
or some definite  malady which does not  get well,
either because  the usual tonics fail, or because their
occupations  in  life  keep them always  in a  state of
exhaustion.   If,  by rest,  we  slow the  machinery,
and by massage  and electricity deprive rest of its
evils,  we can often obtain cures which are to  be  had 
92      DIETETICS AND  THERAPEUTICS.

in no other way.  This is true of many uterine and
some other disorders.
  Miss B., aet. 37, height five feet five inches, weight
one  hundred and fifteen  pounds,  a school-teacher,
without any notable organic disease, had a severe fall,
owing to an  accident while driving.  A slight swell-
ing in  the hurt lumbar region was followed by pain
which became intense when she walked any distance.
Loss of color, flesh, and appetite ensued,  and after
much treatment she consulted me, a year and  a half
ago.  I could find nothing beyond soreness on deep
pressure, and she was anything  but hysterical or
emotional.
  Two months' rest with the usual treatment brought
her  weight  up  to  one hundred  and  thirty-eight
pounds, and  she has been able ever since to  do her
usual work, and to walk when and where and as far
as she wished.
  A year ago I treated with some reluctance a lady
who had  extensive  bronchitis  and a slight albumi-
nuria.  This woman was a mere skeleton, with every
function  out  of order.   I undertook her  case with
the  utmost distrust, but  I  had the pleasure to find
her fattening and reddening like others.  Her cough
left  her,  the  albumen disappeared, and she became
well enough to walk and drive; when a sudden con- 
DIETETICS AND  THERAPEUTICS.      93
gestion of the kidneys destroyed  her in  forty-eight
hours.
   I have ventured, without  much hope, to treat
three cases of phthisis  in the same manner.  There
are cases of this nature in which exercise wearies.
There are others which we cannot  for various rea-
sons send away to more genial climates, and in such
instances we are driven to merely watch the slow
decline of our patients.  I believe that  sometimes,
and especially in the very earliest stages of consump-
tion, my treatment will save  a small percentage of
such people, but, as yet, I only venture to make the
suggestion, and wish distinctly to  state that my ex-
perience in this form of its usefulness is limited.
   One of the  cases treated got well and remained
well.   There  was  every  evidence  of pulmonary
trouble.
   No. 2 improved enormously in all  respects, and
relapsed hopelessly, owing to  large  and repeated
bleeding from piles and rectal fissure.
   No. 3, a male, at 24 was treated by rest and mas-
sage without electricity, and  improved so as  to  re-
sume his wrorkl  He still has slight cough, and has
to be careful, and there  are, as yet, distinct evidences
of inactive disease at the summit of the left lung.
   To save further details, I give a brief summary of 
94      DIETETICS AND  THERAPEUTICS.

eight cases of women, all of whom were thin, feeble,
anaemic, and vexed with some of the endless variety
of pains, aches, and  ailments, real, imaginary, or
exaggerated  by attention, which so constantly mark
these cases.
  Mrs. L., aet. 29, in three months gained eighteen
pounds, and became well and vigorous.
  Miss  R., aet. 28, in two months  gained twenty-
one pounds, and from a bed-ridden invalid became
a strong and quite ruddy woman.
  Miss  L.,  aet.  29,  height  five feet  eight inches,
weight one hundred and  eighteen pounds, in four
months became perfectly well, and rose in weight to
one hundred and sixty-nine pounds.  Two months
were spent in bed.
  Miss E., a nervous, morbid invalid, with a threat
of insanity, and a wretched state of  mind and body,
became quite florid, and rose in weight to one hun-
dred and thirty-two pounds  from one hundred  and
nineteen pounds.
  Mrs. P., a case of curious and incessant sense of
fatigue on walking or standing, gained in six weeks
sixteen pounds,  but  was merely improved, and not
cured.
  Miss  M., aet. 32, at one time a  bright,  cheerful
woman, had a slight fall, and  some moral strains, 
DIETETICS AND THERAPEUTICS.     95
which speedily reduced her to a state of invalidism,
and  made  her so  irritable  and morbid that she
became  a source of  misery alike  to  herself  and
others.  She was well cured  in nine weeks  of rest,
and  became of a good color, but did not gain  over
seven pounds.
  Miss B., a school-teacher, treated at the Infirmary,
was not anaemic.  She had, however, the usual train
of nervous  symptoms,  with irritable  spine.   She
gained thirteen pounds in seven weeks, and seems
well, but as yet has not tested her endurance  by a
return to work.
  Mrs.  R.,  aet.  38, height  five feet three  inches,
weight one hundred and ten pounds, was never  bed-
ridden, but  was  obliged to  lie  down several hours
a day.  She was highly nervous, dreadfully dyspeptic,
and  singularly anaemic.   She was made  able to do
what she pleased, except that I am  obliged to insist
on four hours of daily rest.  Her  change  in  color
was remarkable, and she gained twenty-five  pounds
in nine weeks.
  I could give other  cases of gain  in flesh without
manifest relief.  As I have said, these are rare, but
it is  less uncommon to see great relief without im-
provement  in  weight  at all,  or until the patient is
up and afoot for some weeks. 
 96     DIETETICS AND  THERAPEUTICS.

   I have  mentioned, more than once, the singular
 return of menstruation under this treatment, and as
 examples I add a brief list of the most notable  in-
 stances.
   Mrs. N., aet. 29, no menstruation for five years;
 return of  menstruation at thirtieth day  of treat-
 ment; continued regularly ever  since during three
 years.
   Mrs. C, aet. 42, eight years without menstruation;
 return at fourteenth day of treatment; now regular
 during five months.
   Miss C, aet. 22, no menstruation for eight months;
 return at close of sixtieth day of  treatment; regular
 now for four months.
   Miss A., aet. 26, irregular; missing  for two  or
 three months, and then menstruating irregularly for
 two  or three months.   No  flow for  two  months.
 Menstruated  at nineteenth day  of  treatment, and
 regular during  thirteen months ever  since.
   The relapses into bad health after complete cure
 have been very rare;  but,  of course,  there have
 been  many  instances  in  which I  have merely
amended the health, without perfectly restoring  it.
Yet  even in  these the examples of entire falling
back into the old state have not been discouragingly
numerous, while, on the other hand, I can count a 
        DIETETICS AND  THERAPEUTICS.      97

large number of women who have been rescued  by
my treatment after all else had failed, and who have
ever since  enjoyed  the most  absolute  and  useful
vigor of mind and body.
   I do not doubt that  the statements I have made
will give rise in some minds to that distrust which
the relation of remarkable cures so naturally excites;
and this I cannot  blame.   Every physician  can
number in  his own practice more or less of just such
cases as I have described, and every medical man of
large experience knows that many of these women
are to  him sources  of anxiety or  of therapeutic
despair so deep that after a  time he gets to think of
them as destined irredeemably to a life of imperfect
health.
   I have been happy in the fact that both in private
practice and  at the Infirmary for Nervous Disease,
my cases have  of necessity been  constantly under
the eyes of trained and watchful observers,  to whose
skill  and  care  I am indebted  for many of  the
thermometric and other details of  my cases, and
who  have come at  last to be  amply satisfied by
repeated experience  of the  exceptional value of the
treatment which I now leave to the judgment of the
larger jury of my medical brothers.
                        9 
 
INDEX.
Advantages of seclusion in emo-
  tional cases, 34.
Alcoholism  in  the production
  of fat, 17-19.
American race,  peculiarities of,
  16.
Anaemia accompanying loss  of
  fat, 16.
Anaemia in emotional exhaustion,
  27.
Anaemia produced by dyspepsia,
  24.
Anaemia produced by malaria, 25.
Anaemia with  accumulation  of
  fat, 18.
Anaemic fat cases, 74.
Asthenopia, 86.

Bauer on the production of fat,
  18.
Beard and Rockwell  on  induc-
  tion current,  69.
Bleeding causing deposit of fat,
  18.
Blood in its relation to fat, 21.
Bowditch on weight at different
  ages, 12.

Case  of emotional  exhaustion,
 . 27.
Cases of local pain, with treat-
  ment, 91.
Cases of exhaustion  dependent
   upon anaemia, 30.
Cases, emotional, 25.
Cases of rise in temperature from
  electricity, 68.
Cases, anaemic, fat, 74.
Climate affecting weight, 15.
Cod-liver oil, 77.
Comparison of  Americans  and
  English,  16.
Constipation, treatment of, 75.

Dietetics, 71.
Diet-list (cases reported), 82.
Digestion, weak  (rest in), 45.
Dyspepsia  preventing assimila-
  tion, 24.
Dyspepsia   producing  anaemia,
  24.

Electricity, 30.
Electricity, manner of giving, 63.
Electricity elevating temperature,
  63.
Electricity  affecting temperature,
  64-69.
Emotional  cases, 25.
Emotional  cases, seclusion in, 34.
                      99 
100                      INDEX.
Exercise, rest or tonics, 37.
Exercise, when needed, 39.
Exertion, over-, bad effects of, 40.
Exhaustion, nervous, 25.
Exhaustion, emotional, case of,
  27.
Exhaustion,   dependent   upon
  anaemia, 62.

Fat anaemic cases, 74.
Fat in its clinical relations, 9.
Fat in its relation to health, 21.
Fat in hysterical people, 17.
Fat in old people, 17.
Fat, importance  of assimilation
  of, 9.
Fat-producing diet, 23.

Health, fat in its relation  to,  21.
Holmes on hysteria, 35.
Hysterical paralysis, case of, 73.
Hysterical people, fat in, 17.

Importance of accumulation of
  fat, 9.
Inconstancy of amount of fat, 11.
Induction current, 62,  69.
Introduction, 7.
Iron, preparations to use, 79.

Jackson on rest, 37.

Letheby on fattening stock, 20.

Malarial  poisoning   producing
  anaemia, 25.
Malt, when to use it, 76.
Manner of giving electricity, 63.
Manner of appearance of fat, 20.
Massage,  51.
Massage,  effects of, 54-60.
Massage, effects of on surface cir-
  culation, 61.
Massage, how to employ it, 52.
Massage, influence of on temper-
  ature, 56.
Mechanism of storing fat, 22.
Milk diet, 71.
Milk, amount used, 71, 72.
Moral medication, 43.
Morphia causing production of
  fat, 17-19.
Nervous exhaustion, so-called, 25.
Normal fat of human body, 10.

Over-exertion, bad effects of, 40.

Peculiarities of  American  race,
  16.
Pollock  on  gain of  weight in
  phthisis, 24.

Quality of  fat in normal body, 11.
Quetelet on  weight  at different
  ages, 11.

Rest, 36, 37,  50.
Rest, character of, 41.
Rest, Jackson on, 37.
Rest, bad effects of, how to coun-
  teract them, 51.
Rest in doubtful  cases, 40.
Rest in weak digestion, 45.
Resume of treatment, 75.

Season affecting weight, 13.
Seclusion,  35.
Soup as  a substitute  for  milk,
  73-77.
Stimulus, 76-78.
Strychnia, when to  use it, 80.
Swedish extension,  55. 
INDEX.                      101
Symptoms of emotional exhaus-
  tion, 25.

Tables of temperature after mas-
  sage, 57.
Temperature  elevated  by elec-,
  tricity, 63.
Temperature  affected  by elec-
  tricity, 64-69.
Temperature  affected  by mas-
  sage, 56-57.
Therapeutics, 71.
Tonics, rest or exercise, 37.
Treatment, resume of, 75.

Urine in over-feeding,  81.

Varieties of fat, 19.

Weight affected by season, 13.
Weight affected by climate, 15.
Weight  at different ages, Bow-
  ditch on, 12.
Weight in women, 13. 
 
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