This consists of complete rest in bed, isolation, high feeding, massage, and electricity.

* Dr. Weir-Mitchell of Philadelphia has the honour of having introduced this simple and well-arranged treatment. His work on this subject," Fat and Blood and how to make them," made an enormous impression both in America and Europe, and was translated into German ("Der Behandlung gewisser Formen von Neurasthenie und Hysteric" : Berlin. 1887)

We may begin by stating that the cure is meant for emaciated patients, especially those who are below their normal weight, and often at the same time anaemic, over-worked, and neurasthenic (or hysterical).

Weir-Mitchell used the cure especially for women patients. If the cases are well chosen it is excellent also for men, who formed the majority of my own cases.

In my opinion the indications for the cure, as stated by the genial author of it, are too extensive. Contrary to Weir-Mitchell, I do not use the cure for stout neurasthenics because of my experience in these cases. The corpulent neurasthenic, unlike those who are below normal weight, does not benefit his weak nerves by becoming fatter, and obesity, which is always detrimental, may be produced by the prolonged rest, combined with high feeding; this in particular may affect the heart badly. One of the chief aims of the cure is, therefore, in these cases a disadvantage. Weir-Mitchell tried to remove this by modifying the diet given to stout patients; they, as is often the case with others, were put exclusively upon skimmed milk, but the quantity was reduced to a litre a day. When we consider that, even while resting, 30 calories for every kilogram of body weight are required each twenty-four hours to maintain equilibrium, and that the value of 1 litre of cow's milk which has lost the greater quantity of its fat does not reach 400 calories, it is easily seen that this diet alone is not even a living amount, but is pure starvation. The patients also do become thin under it to a certain extent. But in my opinion under no circumstances should thinness be produced in neurasthenic patients by means of too restricted diet; they become extremely nervous, as I have often had the opportunity of observing, although this deterioration is less noticeable during rest and is partially counteracted by the other parts of the treatment.

Weir-Mitchell, who was warned by some unsuccessful attempts, does not consider his cure suitable for persons suffering from definite melancholia, and this opinion is shared also by Goodall and Playfair. The kind of mental disease and the individuality on the one hand, together with the manner in which the different parts of the treatment (particularly the isolation) are carried out on the other hand, may possibly have some influence; one would expect a priori that the cure would give good results in certain milder cases of melancholia.

The rest in bed gives the most complete rest the patient can obtain, not only for his muscles, but for his mind; it relieves him of the numerous changing impressions and emotions which he meets with in daily life. Further, he is in a position to store up fat, which would otherwise go towards maintaining physical movements. In many cases also it has the great advantage that it makes the patient healthy, owing to the suitable surroundings chosen by the doctor, and does this independently of the patient, who is demoralised by hysteria or neurasthenia. It is easily seen that this is a most important part of the cure, a conditio sine qua non. But we must remember that massage can never take the place of physical exercise in its effect upon the heart and ventilation of the lungs, and that a too continuous rest in bed produces a lowered condition of nutrition. For this reason, when it seems suitable, I allow the patient to take an hour's walk every morning. The rest in bed is otherwise only broken by the patient's daily visits to the bathroom and lavatory, by the evening bed-making, and by weighing the patient once a week if desired.

Isolation aims at giving the patient complete rest of mind, and is certainly of value, but is not equally applicable to all cases. The doctor ought to try to obtain knowledge as quickly as possible of the character of the patient in order to deal rightly in this matter. One patient is extremely irritable and requires as complete isolation as possible; another, though in other ways extremely nervous, is not specially so in this respect, and can bear one or two visits daily from friends, especially if these refrain from discussing matters which excite him, especially his health. Some natures cannot under any circumstances bear long isolation. As a rule one must remember that isolation from the members of his own family is the most important. Although on the one hand one ought always to insist upon a certain amount of isolation, I think, on the other hand, that if one is too pedantically strict in this, and docs not sufficiently consider the individual, one may miss the best results of the treatment.

Combined with the personal isolation we must also consider what we may call intellectual isolation. The patient may only read for a short time each day; . if he suffers from asthenopia, which is not unusual in these cases, he may have a reader for an hour. The newspaper is, as a rule, the least harmful literature.

The diet must be arranged to strengthen and nourish the patient. It ought, therefore, to supply the three different kinds of foodstuffs in large quantities and proper proportion, and aims at putting as little strain as possible on the patient's digestive organs, and avoiding functional disturbance. Milk alone is not satisfactory in these respects for an adult; moreover, very large quantities would be required to give what may be considered a normal amount for a person doing moderate work and a suitable amount for one resting.* One very often sees persons who under normal conditions do not suffer at all from disturbances of digestion, but who cannot take large quantities of milk, not even along with a mixed diet, much less as the one and only food; they get pyrosis, eructations, flatulence, bad taste in the mouth, furred tongue, loss of appetite, constipation, and it is seen that an exclusive milk diet is not the most strengthening and the best tolerated by the digestive organs. These and other obvious reasons have led me to drop the diet used by Weir-Mitchell, and after him by many others.+