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FAT AND BLOOD:
AN ESSAY ON THE TREATMENT OF CERTAIN FORMS OF
NEURASTHENIA AND HYSTERIA.
BY
S. WEIR MITCHELL, M.D., LL.D. HARV.,
MEMBER OF THE NATIONAL ACADEMY OF SCIENCES.
_EIGHTH EDITION._
EDITED, WITH ADDITIONS, BY
JOHN K. MITCHELL, M.D.
PHILADELPHIA:
J.B. LIPPINCOTT COMPANY.
LONDON: 5 HENRIETTA STREET, COVENT GARDEN
1911.
Copyright, 1877, by J.B. LIPPINCOTT & CO.
Copyright, 1883, by J.B. LIPPINCOTT & CO.
Copyright, 1891, by J.B. LIPPINCOTT COMPANY.
Copyright, 1897, by J.B. LIPPINCOTT COMPANY.
Copyright, 1900, by J.B. LIPPINCOTT COMPANY.
Copyright, 1905, by S. WEIR MITCHELL.
ELECTROTYPED AND PRINTED BY J.B. LIPPINCOTT COMPANY, PHILADELPHIA,
U.S.A.
PREFACE TO THE EIGHTH EDITION.
The continued favor which this book has enjoyed in Europe as well as in
this country has rendered me doubly desirous to make it a thorough and
clear statement of the treatment of the kind of cases which it discusses
as carried out in my practice to-day.
In the endeavor to do this, the present edition, like the last two, has
been carefully revised by my son, Dr. John K. Mitchell, and there is no
chapter, and scarcely a page, where some alteration or addition has not
been made, besides those of the sixth and seventh editions, as the
result of added years of experience. Especially in the chapters on the
means of treatment some details have been thought worth adding to help
the statement so often repeated in the book that success will depend on
the care with which details are carried out. The chapter on massage,
rewritten for the last edition, has been once more revised and somewhat
extended, in order to make it an accurate as well as a scientific, if
brief, statement of the best method which use and observation have
taught us. A chapter on the handling of several diseases not described
in former editions has been added by the editor.
S. WEIR MITCHELL.
SEPTEMBER, 1899.
CONTENTS.
PAGE
CHAPTER I.
INTRODUCTORY 9
CHAPTER II.
GAIN OR LOSS OF WEIGHT CLINICALLY CONSIDERED 14
CHAPTER III.
ON THE SELECTION OF CASES FOR TREATMENT 33
CHAPTER IV.
SECLUSION 50
CHAPTER V.
REST 67
CHAPTER VI.
MASSAGE 80
CHAPTER VII.
ELECTRICITY 108
CHAPTER VIII.
DIETETICS AND THERAPEUTICS 119
CHAPTER IX.
DIETETICS AND THERAPEUTICS--(_Continued_) 171
CHAPTER X.
THE TREATMENT OF LOCOMOTOR ATAXIA, ATAXIC
PARAPLEGIA, SPASTIC PARALYSIS, AND PARALYSIS
AGITANS 197
INDEX 233
CHAPTER I.
INTRODUCTORY.
For some years I have been using with success, in private and in
hospital practice, certain methods of renewing the vitality of feeble
people by a combination of entire rest and 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 a 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 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.
In 1875 I published in "Séguin's Series of American 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
letters I have received asking for explanations of the minutiæ of
treatment; and this must be my apology for bringing into these pages a
great many particulars which are no doubt well enough known to the more
accomplished physician.
In the preface to the second edition I said that as yet there had been
hardly time for a competent verdict on the methods I had described.
Since making this statement, many of our profession in America have
published cases of the use of my treatment. It has also been thoroughly
discussed by the medical section of the British Medical Association, and
warmly endorsed by William Playfair, of London, Ross of Manchester,
Coghill, and others; while a translation of my book into French by Dr.
Oscar Jennings, with an introduction by Professor Ball, and a
reproduction in German, with a preface by Professor von Leyden, have
placed it satisfactorily before the profession in France and Germany.
As regards the question of originality I did not and do not now much
concern myself. This alone I care to know, that by the method in
question cases are cured which once were not; and as to the novelty of
the matter it would be needless to say more, were it not that the charge
of lack of that quality is sometimes taken as an imputation on a man's
good faith.
But to sustain so grave an implication the author must have somewhere
laid claim to originality and said in what respect he considered himself
to have done a totally new thing. The following passage from the first
edition of this book explains what was my own position:
"I do not wish," I wrote, "to be thought of as putting forth anything
very remarkable or original in my treatment by 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 service to my
profession by relating my experience."
The following quotation from Dr. William Playfair's essay[1] says all
that I would care to add:
"The claims of Dr. Weir Mitchell to originality in the introduction
of this system of treatment, which I have recently heard contested
in more than one quarter, it is not my province to defend. I feel
bound, however, to say that, having carefully studied what has been
written on the subject, I can nowhere find anything in the least
approaching to the regular, systematic, and thorough attack on the
disease here discussed.
"Certain parts of the treatment have been separately advised, and
more or less successfully practised, as, for example, massage and
electricity, without isolation; or isolation and judicious moral
management alone. It is, in fact, the old story with regard to all
new things: there is no discovery, from the steam-engine down to
chloroform, which cannot be shown to have been partially foreseen,
and yet the claims of Watt and Simpson to originality remain
practically uncontested. And so, if I may be permitted to compare
small things with great, will it be with this. The whole matter was
admirably summed up by Dr. Ross, of Manchester, in his remarks in
the discussion I introduced at the meeting of the British Medical
Association at Worcester, which I conceive to express the precise
state of the case: 'Although Dr. Mitchell's treatment was not new
in the sense that its separate recommendations were made for the
first time, it was new in the sense that these recommendations were
for the first time combined so as to form a complete scheme of
treatment.'"
As regards the acceptance of this method of treatment I have to-day no
complaint to make. It runs, indeed, the risk of being employed in cases
which do not need it and by persons who are not competent, and of being
thus in a measure brought into disrepute. As concerns one of its
essentials--massage--this is especially to be feared. It is a remedy
with capacity to hurt as well as to help, and should never be used
without the advice of a physician, nor persistently kept up without
medical observation of its temporary and more permanent effects.