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HOW TO MAKE THEM
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BY
S. WEIR MITCHELL, M.D.,
MEMBER of T.III. NATIONAI, Ac VDEMY of scIENCES; PIIYsioſ V N To Tii E ort ſtopſ. DIG
Hospit VI, AND INFIRMARY Folt Diseases of Tilt, NER vous syst EM ; FEI, Low of
TIIF PHILADEI.PIIIA COLLEGE OF PIIYSICIANS ; MEMBER OF THE AM CitiC AN PII II,_
osopiſ IC AI, sociFTY; MEMBER of Til E N Ew York AcAD 1 MY of Mt Dicis E.;
ASSOCIATE FELLOW OF THE AMERICAN ACADEMY OF ARTS AND Sci FNC Es,
BOSTON ; HoNo RARY MEMBER OF THE NEW J ERSEY STATE MEDICAL So-
CIETY; HONORARY CORRESPONDING MEMBER of TIIE BRITISH MEDICAL
ASSOCI \TION ; II) NORARY MEMBER OF THE ST. ANDREW’s MEDICAL
GRADUATES’ Associ ATION ; For EIGN Associ.ATE of THE Roy AL
MEDICAL soci FTY of Norw.V.Y.; AUTiion of “A Titº VTise ox
INJURIES OF THE NERVEs,” “WEAR AND TEAR,” ETC.
SECOND EDITION, REVISED.
I’ HIL AD EL PHIA :
J. B. LIP PIN COTT & O O.
L O N D O N :
16 SOUTHAMPTON STREET, COVENT GARDEN.
1879.

Copyright, 1877, by J. B. LIPPINCOTT & Co.
D E D I (, ATI () N.
TO
JOHN FORS YTH MEIGS, M.D.,
IN GRATEFUL REMEMBRANCE OF MANY ACTS OF FIRIENDLY
SERVICE.
S. W E IIR, MIT C H E L L.
C O N T E N T S.
PAGE
O H A PT E R I.
INTRODUCTORY tº * e tº tº sº º . 9
C H A P T E R II.
FAT IN ITS CLINICAL RELATIONS . e * i.e. , 11
C H A P T E R III.
SECLUSION g & tº g tº e ſº º . 36
C EIA PT E R IV.
REST te º . . ve º º º * . 38
C H A PTE R. W.
MASSAGE . º tº & sº tº © © * > . 53
C H A P T E R W I.
ELECTRICITY . we & ( & * e * º . 64
C EIA P T E R W II.
DIETEtics AND THERAPeutics—GENERAL RESULTs—
CASES * º & wº wº tº & & . 73
1% 5
PREFACE TO THE SECOND EDITION.
THE early call for a second edition of this little
volume has satisfied me that I was right in my
belief that the profession was ready to examine any
promising means of treating a class of disorders
which it has never found easy to deal with. As
yet there has hardly been time for physicians to
give their verdict on the methods I have described.
I am able, however, to add cases which have been
watched and treated by others, and I have made
Some few additions to the text.
FA. T A N D B TL O O D :
ANID
HOW TO MAKE THEM.
C H A P T E R 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
A* 9
10 INTRODUCTORY.
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 “Séguin's Series of Ameri-
can Clinical Lectures,” Vol. I. No. 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.
C H A P T E R 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 ſat 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
11
12 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
FA T IN ITS CL.INI CAL RELATIONS. 13
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.
Quetelet' 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.
2
14 FAT IN ITS CL IATICAL REI, ATIONS.
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.
Dr. Henry I. Bowditch" reaches somewhat similar
conclusions, 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 CI, IVICA I, RELATIONS. 15
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
| 6 FA T IN ITS CL.INI CA I, REI, ATIONS.
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 originate"
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
take on fat, and I think the first thing which strikes
* See a valuable paper by Dr. Gerhard. Am. Journ. Med.
Sci., 1876.
F.ſ T IN ITS CL.INICA I, REI, A TI O N.S. 17
an American in England is the number of inordi-
nately fat middle-aged people, and especially of ſat
WOIllen.
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
2%
18 FA T 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 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. H. I.
Bowditch has lately made clear; while the English of the
manufacturing and agricultural classes are miserably inferior
to the members of a similar class in America.
FAT IN IT'S CL.INICAL RELATIONS. 19
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
20 PAT IN ITS CL.INICA I, 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.
Bauer' 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 explanations
aid us but little to comprehend what after all is only
met with in certain persons, and must therefore in-
volve 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 für Biol., 1872. Phil. Med. Times, vol. iii.
page 115. -
FA T IN ITS CL.INI CA I, IRE I, ATIONS. 2]
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, L
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.
22 FA T IN ITS CL.INICAL RELATIONS.
/
Letheby, “is to overcome excessive tendency to
accumulation of either surface ſat 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
* Letheby on Food, pp. 39, 40, 44.
FA T IN ITS CLIMICA1 L IRE LATIOA.S. 23
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 compara-
tively thin long after other parts have made remark-
able 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
24 FA T IN ITS CLINICAI, 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 lessencd
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 CL.INICAI, IRELATIONS. 25
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
IS 3
26 FAT IN ITS CL.INICAL RELATIONS.
temporary maladies, gather flesh and make blood
readily, 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 because
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 irrational 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. 27
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
\
28 I'A T IN ITS CLINICAI, 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. 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 hysteri-
cal, 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 exhaustion which ensues is in proportion to the
exercise used.
I have rarely seen such a case which was not more
FAT IN ITS CL.INI CA I, JPEI, A TIONS. 29
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 stimu-
3×
30 FA T IN ITS CLINICA I, RELATIONS.
lus and endless tonics. Then comes the mischievous
rôle 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
general 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 con-
stipation which further annoy the patient and embar-
rass 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
feebleness. 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 be-
come, under the influence of painful nerve-wounds,
as irritable and hysterically emotional as the veriest
girl. If no rescue comes, the fate of women thus
disordered 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
;
:
o
:
:
:
:
*
FAT IN ITS CLINICA I, RELATIONS. 31
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
32 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."
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 dif-
ficult to define. The two people who, owing to
their relationship, depend the one on the other, are
for no good reason made unhappy by their several
1 tº Nurse and Patient,” S. Weir Mitchell, Lippincott's
Magazine, Dec. 1872.
FAT IN ITS CLINICAL RELATIONS. 33
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. Why 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
B%
34 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.
fºr
The treatment I am about to describe consists in
I'AT IN ITS CL.INICAL RELATIONS. 35
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.
C H A P T E R 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 necdful 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
36
SECD, USION. 37
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.
I should add here a few words of caution as to the
time of year best fitted for treatment. In the sum-
mer seclusion is often undesirable when the patient
is well enough to gain help by change of air; more-
over, at this season massage is less agreeable than in
winter, and, as a rule, I find it harder to feed and
to fatten persons at rest during our summer heats.
That this rule is not without exception is shown by
a case which I have quoted in the final chapter.
4
^,
C II A P T E R IV.
EEST.
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,
38
JR EST. 39
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. Séguin'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
40 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 casy, 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. Dut 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. 41
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
sole means of cure. The time comes for that, but it
should not come until entire rest has been used, with
- 4%
42 JR EST.
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, but when they are bidden to
stay in bed a month, and neither to read, write, nor
REST. 43
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-
44 JREST.
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, T 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. 48
&A
capacity to digest food, and the growing hope off
final cure, fed as it is by present relief-all conspire
|
f
A
to make most patients contented and tractable. {
The moral uses of enforced rest are readily esti-
Yº-
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.
Ali 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
46 R EST.
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 eat-
ing, 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, um-
able to evolve at the same time the force necded 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
JR EST. 47
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 magnificd 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 reed-
fal, as I shall show, to bring to our help certain ther
48 IRIST.
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 case, 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, cKact 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,
R EST. 49
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.””
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
* Lecture, op. cit.
C 5
W
50 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., act. 52, who was brought to the
Infirmary from New Jersey, having been supine in bed fif.
teen years. I soon knew that she was frce 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
massage 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 blood-
REST. 51
less, 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.”
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
* 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.
52 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.
C H A PTE R. W.
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
systematic massage used by a charlatan in a case
of progressive paralysis. The temporary results he
obtained were so remarkable that I began soon after
5% 53
54 MASSA G.E.
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 agent 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-
MASSA G.E. 55
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 ſavor 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,
56 MIASSA (; E.
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 necdful to have
the limbs shaved, because the constant pull made on
the hairs gives rise to very troublesome and painful
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- i
regarded, because they pass away in a few days, and
MASSA G.E. 57
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
Cº.
58 MASSA G. E.
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
MASSA G. E. 59
*
what the act of kneading may be expected to bring
about, and CSpecially in such as are thin and anaemic,
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 Massage. After Massage.
100 e e © * > tº g e 100
100 . . . . . . . 101;
993 . . . . . . . 99;
99% . . . . . . . 100
993 . . . . . . . 100
100 ſº e © © tº & ſº 100
99; . . . . . . . 100
99; . . . . . . . 100
Miss P., aet. 24, hysteria.
Before Massage. After Massage.
99} Q & © º e º º 99}
98} . . . . . . . 99
60
Before Massage.
98}
98} tº gº
98} tº e
99 T. .
100% & ©
100% º
100% e
1003
After Massage.
. 99
. 99
98}
99;
100%
1013
100%
100
Mrs. L., a very thin, feeble, and bloodless woman,
aet. 29 years.
Before Massage.
99 dº
98} º
98
99 e
983 gº
99
100 tº G
99 gº º
Mrs. P., act. 31, feeble and anaemic, nervous,
slight albuminuria and chronic bronchitis. Liable
After Massage.
100
100
983
993
1004
. 99%
to fever. 3 P.M.
Before Massage.
1013 ©
100 tº º
99 & Co
100 © 0.
993
After Massage.
... 102
. 100%
. 99%
101
100%
MASSA G.E. 61
Before Massage. After Massage.
99% . . . . . . . 100%
1003 . . . . . . . 1013
100% tº e e o & © tº 99%
100% . . . . . . . 100%
100% . . . . . . . 100;
99% º º e º e º e 99;
These temperatures were taken always before 4
P.M., and at intervals of three days. Her, morning
temperature was usually 99° to 994%, 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., aet. 21, hysteria, good condition.
Defore Massage. After Massage.
98 * @ e º º e e 973
98% . . . . . . . 98%
98 Qe ſº e e ę tº e 98
983 • . . . . . . 98
98; • . . . . . . 98
As menstruation is sometimes in very excitable
people arrested by massage, I usually order the i
6
62 MASSA G 10.
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 be, 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 aſter
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
f
MASSA G. F. 63
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
allows it to flow back anew, thus healthfully ex-
citing 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 ves-
sels 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-
mence 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 firmness of the tissues is often of great use
to ble.
C H A P T E R V I.
IELECTRICITY.
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
64
JELECTRICIT Y. 65
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
- 6%
66 ELECTRICITY.
tubercular disease of the apex of the right lung.
She had a morning temperature of 98% to 99%, and
an evening temperature of 100 to 102.
Electricity was used about 11 o'clock daily, with
these results:
Before Llectricity. After Electricity.
November 25 . & jº . 99 993
{ { 27 . & * . 97% 100
{ { 28 . tº & . 98 99
( & 29 . tº s . 98% 99%
December 2 . § º . 100% 1013
{ { 4 . § & . 99% 100%
{ { 5 . g g . 993 99%
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 thir-
teen 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.
Before Llectricity. After IElectricity.
April 2 . © e ſº . 983 98%
“ 3 . . . . . 98 983
{ { 4 . g tº & . 98 98
#
EI, ICC TRICITY. 67
Before IEloctricity. After Electricity.
April 5 98 983
“ 6 . . 97+%; 98.1%
tº 7 . . 98 98.1%
tº 8 . 98 983
tº 9 98 994's
‘‘ 10 . . 98% 983
tº 11 . . 98 fºr 98.1%
4t 12 . . 983 99T;
“ ( 13 . . 98% 99.1%;
** 14 . . 983 99%
** 16 . . 98 ºr 991's *.
tº 17 . . 98.1% 99%;
tº 18 . . 98.1% 9915 one hour later, 99T;
“ 19 . . 981%; 99; “ “ “ 984
tº 20 . . 99 994's
{{ 21 . . 981%; 99%;
Menstrual period.
4t 30 . . 983 983
May 1 . . 98 98.1%
( ; 2 . . 98 98 fºr
The third case, Miss M., aet. 33, was that of a
pallid woman, the daughter of a well-known physi-
cian in the south. She suffered for six years with
“nervous exhaustion,” headaches, pain in the back,
intense depression of spirits, nausea, and repeated at-
tacks 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
68 ELECTRICITY.
thorough recovery, and was restored to useful,
active life.
Miss M. Thermometer held in mouth five min-
utes before and after treatment.
Defore Electricity. After Iºlectricity.
May 14 . 991's 994, ) Menstruating; general faradi-
{{ 15 . 99 99; } zation only.
tº 16 . 99; 99% Gen'] faradization and limbs.
« 17 . 984 99%
4 18 . 98; 99%
( ; 19 . 984 983
tº 21 . 983 99
tº 22 . 98% 9915
tº 25 . 9846 984;
tº 20 . 98.5 9915
tº 29 . 983 99
tº 30 . 98.1% 99T;
( ( 31 . 98.1% 9915
Mrs. P., aet. 38, was a rather nervous woman,
casily 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 . 983 99%. Thermometer in axilla ten
“ 29 . 983 994 minutes before and after.
“t 30 . 994 993
tº 31 . 98% 993
February 1 . 99 993
ELECTRICITY. 69
Menstrual period.
Before Electricity. After Electricity.
February 8 . 983 99%
{ { 9 . 983 99
tº 10 . 983 99
tº 12 . 98% 993
tº 13 . 983 99
** 14 . 983 983
* 15 . 98% 98%
tº 19 . 99 983
tº 20 . 98 99
tº 23 . 983 993 Thermometer in mouth five
“t 24 . 99 993 minutes before and after.
tº 27 . 99% 993
tº 28 . 98% 993
Menstrual period.
March 13 . 99 993
! ( 14 . 98% 98%
tº 15 . 99 99%
Miss R., aet. 27, was a fair case of hysterical con-
ditions; overusé 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 G l tº s º
tº 16 ... 100 100 G.In el’:). Andation for fif-
teen minutes.
tº 17 . 100% 1003
( ; 18 . 983 983 ) Gen’l faradization and arm
tº 19 . 99; º muscles twenty minutes.
70 EI, ECTRICITY.
Before Electricity. After Electricity.
May 20 . 100 ºf 100 General ſaradization, ten
tº 22 . 993 99; minutes; arms and legs,
tº 26 . 994's 994%; twenty minutes.
tº 27 . 99; 994,
tº 28 . 993 993
“ 29 . . 99%, 99%;
“ 30 . 99 ºf 99.1%;
{{ 81 . 991's 99%;
June 2 . 993 99;
( ( 4 . 99.1%; 994%;
4t 6 . 99%, 99.1%;
tº 7 . 99%; 994;
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. 7 1
crease in the ordinary rate of disintegrative change 2
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 Tockwell 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
72 FLECTRICITY.
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 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.
I have been asked very often if all of the means
here described be necessary, and I have been criti-
cised by some of the reviewers of my first edition
because I had not pointed out the relative needful-
mess of the various agencies employed. In fact, I
have made very numerous clinical studies of cases,
in some of which I used rest, seclusion, and massage,
and in others rest, seclusion, and electricity. It is,
of course, difficult, I may say impossible, to state in
any numerical manner the reason for my conclusion
in favor of the conjoined use of all of these means.
If one is to be left out, I have no hesitation in saying
that it should be electricity. !
C H A P T E R W II.
DIETETICS AND THERAPEUTICS.
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
fat
as well as anaemic. As to this latter class, it is
those who are, seem apt to be—in a few cases
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.
D 7 73
74 DIETETICS AND THIERA PEUTICS.
—-7
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., act. 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 THERAPE UTICS. 75
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
successful 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 fatness with anaemia, it is sometimes necessary to
substitute beef-soup for a day at a time 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 annount. Her stomach-troubles,
76 I) IETE (ITICS AND THIERAI2E UTICS.
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 THEIRAPE UTICS. 77
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 onlit 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. aloës
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
7%
t
\
78 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
A 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. jº
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
8:52
largely by being fed by her attendant. People who
and the patient is made to eat more
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
DIETETICS A ND THE RA PEUTICS. 79
the fork 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-
eess 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
80 DIETETICS AND THIERA PE UTICS.
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 enemata
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 THE IRAI2E UTICS. 81
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 mect 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
ID *
82 DIETETICS AND THIER A PIC UTICS.
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.
aloës 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."
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
* This is now admirably made, on a large scale, by Wyeth
& Co., of Philadelphia.
DIETETICS AND THIERA PEUTICS. 83
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 inpunity 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
84 I) IETETICS AND THI ERA PEUTICS.
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 AND THEI&A I’EUTICS. 85
wearied her : to eat, to drive, to read, to sew. Walk-
© e ſº tº !
ing became impossible, and, tied to her couch, she
A. -
grew dyspeptic and constipated. The asthenopia
which is almost constantly seen in such cases added
to her trials, because reading had to be abandoned,
and so at last, despite unusual vigor of character,
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
8
:
}
|
!
|
86 DIETETIOS AND TIIERA PEUTICS.
pill of aloes every night, which answered for a few
days.
12 to 15.
time was relieved, and she slept without her habitual
Same diet. The dyspepsia by this
dose of chloral. The pint of raw soup was added
in three proportions 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. clectricity was used for an hour in
the manner which I have described.
DIETETICS AND THER A PEUTICS. 87
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-
88 DIETETICS AND THIERA PEUTICS.
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 dict and treatment
I do not wish it to be considered as applicable to all
"ases. 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 THIERA PEUTICS. 89
As additional illustrations I shall now state a few
cases, and I shall not enter into minute details of
trCatment.
The following case is reported by Dr. John Keat-
ing, who watched it with care throughout :
Mr. P. D., aet. 53, after more than thirty years
of close attention to business, which severely tried
both mental and physical endurance, found himself,
in January, 1877, at the close of some months of
gradually increasing feebleness, absolutely unable
to fulfil his usual duties, and the most alarming
symptoms manifested themselves. There was utter
º
prostration of nervous and muscular force; his limbs
refused their support; his appetite failed; the recol-
lection of ordinary phrases involved distinct and
painful effort; sleep became unattainable, except
under the influence of powerful narcotics, and even
that brief slumber was rendered valueless by the
incessant convulsive twitching of the muscles.
His physician prescribed iron and strychnia;
ordered an immediate abandonment of all business
and instant departure to a point where telegraph
wires were unknown and mails infrequent. He
went at once to the Bahamas, passing a month in
that delicious climate in absolute inaction; more than
another month was consumed in slowly returning,
8% *.
90 DIETETICS AND THERAPE UTICS.
but, though some flesh had been gained, there was
only a trifling improvement in the nervous condition.
May 1, 1877, Dr. Mitchell examined Mr. P. D.
The patient was sallow and emaciated, and coughed
every few moments. He had night-sweats, nervous
twitching, and slight dulness on percussion at the
apex of the right lung, with prolonged expiration
9.
and roughened inspiration, and some increase of
vocal resonance.
Mr. P. D. was allowed to be out of bed once a
day four hours, and to spend one at his place of
business. The treatment was as follows:
At 6 A.M., a tumbler of strong, hot beef-tea, made
from the Australian extract.
At 8 A.M., half a tumbler of iron-water, and
breakfast, consisting of fruit, steak, potatoes, coffee,
and a goblet of milk.
At 8.30 A.M., a goblet of milk mixed with a
dessert-spoonful of Locſland's extract of malt, with
6 grains of citrate of iron and quinine.
At 10 o'clock Dr. Keating administered the elec-
tricity.
At 12 o'clock Mr. P. D. might be dressed, making
as little personal effort as possible. The second
goblet of milk and malt was administered, and a
carriage took him to his office, where he might re-
©
DIETETICS AND THER A PE UTICS. 91
main till 2 o'clock, when the carriage brought him
for dinner, preceded by half a tumbler of iron-water.
All walking was forbidden.
After dinner (which included a goblet of milk)
the third goblet of milk and malt was swallowed;
then a short drive might be taken, but by 4 o'clock
the patient must be undressed and in bed.
At 6 P.M. the third dose of iron-water presented
itself, and a light supper of fruit, bread and butter,
and cream, followed by the fourth goblet of milk
and malt. Two quarts of milk were thus swallowed
every day in addition to all other food.
At 9 P.M., massage one hour, with cocoa oil, fol-
lowed by beef-soup, four ounces.
At the fourth week the soup was given up; dias
lyzed iron substituted for all other forms. June 4,
electricity was given up. The malt was continued
until June 20.
May 6, Mr. D. weighed in heavy winter dress one
hundred and twenty-five pounds; June 20, in the
lightest Summer garb, he weighed one hundred and
thirty-three pounds; in August it rose to one hun-
dred and forty pounds, and he has continued to gain.
He is strong and well, has no cough, and has ceased
a delicate man.
to be what he had been for years
I am in debt to Professor Goodell for the follow-
92 DIETETICS AND THIERA PEUTICS.
ing case, which I never saw, but which was carried
on with every detail of my treatment. As the tes-
timony of an admirable observer, it is valuable evi-
dence. Professor Goodell writes as follows:
“DEAR DOCTOR MITCHELL :
“You asked me to give you the history of one of
my patients who was cured by the treatment you so
warmly advocate. I gladly do so, because it is a
typical example of what your treatment can effect.
“Some four years ago, Mrs. Y., a very highly in-
telligent lady, from a neighboring city, came to con-
sult me. She suffered dreadfully at each monthly
period, and had constant ovarian pains and a weary-
ing back-ache, which kept her on a lounge most of
the day. She was also barren, and altogether in a
pitiable condition. After a two months’ treatment
she returned home very much better, and soon after
conceived. As pregnancy advanced many of her old
symptoms came back, but it was hoped that mater-
nity would rid her of them. The shock of the labor,
however, proved too great for her already shattered
nervous system. She became far more wretched than
before, and again sought my advice.
“At this time I found all her old pains and aches
running riot. She got no relief from them night or
DIETETICS AND THIER A PEUTICS. 93
day without large doses of chloral. The slightest
exertion, such as sewing, writing, and reading for a
few minutes, greatly wearied her. Even the simple
mental effort of casting up the weekly housekeeping
expenses of a very small household tupset her, and
she had to give it up. The act of walking one of
our squares, or of going down a short flight of stairs,
or of riding for an hour in a well-padded carriage,
gave her such “unspeakable agony’—to use her own
words—that she would have a hysterical attack of
Screams and tears. So emotional had this constant
nerve-strain made her that she could not sustain an
ordinary conversation without giving way to tears.
Much of her time was spent in bed; in fact, she was
practically bedridden.
“I tried in vain to weam her from her anodynes,
and failed altogether in doing her any good, although
many remedies were resorted to, and various modes
of treatment adopted. Finally, in sheer despair, I
put her to bed, and began your treatment of rest,
with clectricity, massage, and frequent feeding. The
first trace of improvement showed itself in a greater
self-control, and in a Jessening of her aches and pains.
Next, smaller doses of the anodyne were needed,
until it was wholly withheld. Then she began to
pick up an appetite, which, towards the close of the
ſ
{
94 DIETETICS AND THERAPE UTICS.
treatment, became so keen that, between three good
meals every day, she drank several goblets of milk
and of beef-tea. At the outset I had stipulated for
six weeks of this treatment, and it was with reluc-
tance that my patient yielded to my wish. But
when the time was up she had become so impressed
with the wonderful benefits she had received and
was receiving, that she begged to have the treatment
continued for two weeks more. At the end of that
time she had gained at least thirty pounds in weight,
and had lost every pain and ache. Her night-ter-
rors, which I forgot to mention as one of her dis-
tressing symptoms, had wholly disappeared, and she
could sleep from nine to ten hours at a stretch. I
now sent her into the country, where she is continu-
ing to mend, and is astonishing her friends by her
scrambles up and down the steep hills.
“Such were the salient features of this case, and I
can assure you that I was as much impressed by the
happy results of the treatment as were a host of
anxious and doubting friends.
“Very faithfully yours,
“WM. GOODELL.”
Miss C., an interesting woman, aet. 26, at the age
of 20 passed through a grave trial in the shape of
I) IETETICS AND THEIRAPE UTICS. 95
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
successive strains her naturally sturdy health gave
way. First came the pain in the back, then grow-
ing paleness, 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 inter-
rupted by increase of the menstrual flow, with un-
usual pain and persistent ovarian tenderness. Very
soon she began to drop her work for a day at a
time. Then came an increasing asthenopia with
evening headaches, until her temper changed and
became capricious and irritable. When I saw her
she had been forced to abandon all labor and had
been treated by an accomplished gynaecologist, and
was said to be cured of a prolapsus uteri and of ex-
tensive ulceration, despite which relief she gained
nothing in vigor and endurance, and got back
neither color nor flesh.
She went to bed December 10 and rose for the
first 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
96 I) IETETICS AND THERAPEUTICS.
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 irri-
table 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
rarely out of bed. Surrounded by highly sympa-
thetic relatives, to whom chronic illness was some-
what novel, she speedily developed 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 household 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 ex-
actions 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. *
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
DIETETICS AND THERAPE UTICS. 97
food, she took next to none, and I could only guess
her weight at about ninety pounds. She was in
height five fect 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 dict 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 was so remark-
able that the process of repair might well have been
called a renewal of life. :
She went home changed no less morally than phy-
sically, and resumed her place in the family circle
and in social life, a healthy and well-cured woman. \
9
98 DIETETICS AND THERAPE UTICS.
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
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.
§AL LIBR.
QY ~~~~
- Jaiversity of)
- f º sº ...”
DIETETICS AND THERAPEUTICs >{{phºtº
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 ſº
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
in no other way. This is true of many uterine and
Some other disorders.
Miss B., act. 37, height five feet five inches, weight
one hundred and fifteen pounds, a school-teacher,
without any notable organic disease, had a severe fall,
:
.
:
:
° e
* e
© tº
Qe

100 I) IETE TICS AND THIERA PE UTICS.
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-
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.
:
o
º
©
o
© e
© e
© tº
JDIETIETICS AND THERAPE UTICS. 101
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 work. 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
cight 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. g
9%
102 DIETETICS AND THIER A PE UTICS.
Mrs. L., act. 29, in three months gained cighteen
pounds, and became well and vigorous.
Miss R., act. 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., act. 32, at one time a bright, cheerful
woman, had a slight fall, and some moral strains,
which speedily reduced her to a state of invalidism,
and made her so irritable and morbid that she be-
came 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.
I) IETETICS AND THERAPEUTICS. 103
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.
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-
104. JDIETE TICS AND THE RAI2E UTICS.
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., act. 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.
I had at one time intended to give, in the first
edition of this work, a full list of all my cases, with
the results, but what were easy to do in definite
maladies like typhoid fever becomes hard in cases
such as I here relate. In the fever the statistics are
simple—patients die or get well; but in cases of
nervous exhaustion, so called, it is impossible to
state accurately the number of partial recoveries,
or, at least, to define usefully the degrees of gain.
For these reasons I have not attempted to furnish
full statistics of the large number of cases I have
treated.
The relapses into bad health after complete cure
DIETETICS AND THIERA PE UTICS. 10.5
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
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
E%
106 DIETETICS AND THERAPE UTICS.
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.
T N T) E X.
Advantages of seclusion in cmo-
tional cases, 36.
Alcoholism in the production of
fat, 19.
American race, peculiarities of,
18.
Anaemia, accompanying loss of
fat, 18.
Anaemia in emotional exhaustion,
29.
Anaemia produced by dyspepsia,
26.
Anaemia produced by malaria,
27.
Anaemia with accumulation of
fat, 20.
Amaemic fat cases, 76.
Asthenopia, 88.
Bauer on the production of fat,
20.
Beard and Rockwell on induction
current, 71.
Bleeding causing deposit of fat,
20.
Blood in its relation to fat, 23.
Bowditch on weight at different
ages, 14.
Case of emotional exhaustion,
27.
Cases of local pain, with treat-
ment, 95.
Cases of exhaustion dependent
upon anaemia, 32.
Cases, emotional, 27.
Cases of rise in temperature from
clectricity, 66.
Cases, anaemic, fat, 76.
Climate affecting weight, 17.
Cod-liver oil, 79.
Comparison of Americans and
English, 18.
Constipation, treatment of, 77.
Dietetics, 73.
Diet-list (cases reported), 84.
Digestion, weak (rest in), 47.
Dyspepsia preventing assimila-
tion, 26.
Dyspepsia producing anaemia, 26.
Electricity, 32.
Electricity, manner of giving, 65.
Electricity elevating
ture, 65.
Electricity aſſecting temperature,
66–71.
Fumotional cases, 27.
tempera-
Eumotional cases, seclusion in, 36.
I}xercise, rest or tomics, 39.
£xercise, when needed, 41.
107
108
I W D EX.
Exertion, over-, bad offects of, 42.
Exhaustion, nervous, 27.
Exhaustion, emotional, case of,
29.
Exhaustion,
anaemia, 64.
dependent upon
Fat anaemic cases, 76.
Fat in its clinical relations, 11.
Fat in its relation to health, 23.
Fat in hysterical people, 19.
Fat in old people, 19.
l'at, importance of assimilation
of, 11.
Fat-producing dict, 25.
Health, ſat in its relation to, 23.
IIolmes on hysteria, 37.
IIysterical paralysis, case of, 75.
IIysterical people, ſat in, 19.
Importance of accumulation of
fat, 11.
Inconstancy of amount of ſat, 13.
Induction current, 64, 71.
Introduction, 9.
Iron, preparations to use, 81.
Jackson on rest, 39.
Lethcly on fattening stock, 22.
Malarial
amas mia, 27.
Malt, when to use it, 78.
Manner of giving electricity, 65.
poisoning producing
Manner of appearance of fat, 22.
Massage, 53.
Massage, effects oſ, 56–62.
Massage, effects of, on surface cir-
culation, 63.
Massage, how to employ it, 54.
Massage, influence of, on temper-
ature, 58.
Mechanism of storing fat, 24.
Milk diet, 73.
Milk, amount used, 73, 74.
Moral medication, 45.
Morphia causing production of
fat, 19–21.
Nervous exhaustion, so-called,
27.
Normal fat of human body, 12.
Over-exertion, bad effects of, 42.
Peculiarities of American
1S.
Pollock on gain of
phthisis, 26.
race,
weight in
Quality of fat in normal body,
13.
Quetelet on weight at different
ages, 13.
Rest, 38, 39, 52.
Rest, character of, 43.
Rest, Jackson on, 39.
Rest, bad eſſects of, how to coun-
teract them, 53. -
Rest in doubtful cases, 42.
Rest in summer, 37.
Rest in weak digestion, 47.
Résumé of treatment, 77.
Season affecting weight, 15.
Seclusion, 36.
Soup as a substitute for milk,
7 5–79.
Stimulus, 78–80.
IND EX.
109
Strychnia, when to use it, 81.
Swedish extension, 57.
Symptoms of emotional exhaus-
tion, 27.
Tables of temperature after mas-
Sage, 59.
Temperature elevated by clec-
tricity, 65.
Temperature affected by elec-
tricity, 66–71.
Temperature affected by massage,
58, 59.
J
10
Therapeutics, 73.
Tonics, rest or exercise, 39.
Treatment, résumé of, 77.
Urine, in over-feeding, 83.
Varieties of fat, 21.
Weight affected by season, 15.
Weight affected by climate, 17.
Weight at different ages, Bow-
ditch on, 14.
Weight in women, 15.
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