This treatment consists of isolation, rest, excessive feeding, massage, and electricity. The two latter are given to counteract the ill-effects which would otherwise result from complete rest and much feeding. If a patient is kept in bed and fed at short intervals for weeks, some means must be adopted to make up for the loss of habitual exercise, which is inevitably massage and electricity. Dr. Weir-Mitchell of Philadelphia, the originator of the treatment, advises that, if possible, the •treatment should begin at the close of the menstrual period.

At first the patient is not allowed to feed herself or to use her hands in any way. It is found that more food is taken if the patient is fed by the nurse. The nurse sponges the patient all over daily in bed.

After a fortnight the nurse is allowed to read aloud. Towards the end of the treatment, which may last six weeks or two or three months, the patient is allowed to sit up in bed and occupy herself with some light work ; she may also feed herself, the food being cut up for her ; then she is allowed to sit out of bed for a few minutes at bedtime. Later on she sits up for a quarter of an hour twice a day ; the time is gradually increased, till she rests on the bed for only about three hours a day. Massage is kept up all the time ; the time is gradually decreased towards the end, till it is given only three times a week, an hour each time. Half the time is given to Swedish exercises, to prepare for walking.

Feeding.—The patient is gradually put on milk diet, one quart daily in divided doses of 3 or 4 ounces. It may be warm or cold, and barley, rice or lime water added to aid digestion. A cup of black coffee, without sugar, is given in the early morning to regulate the bowels. In a couple of days the milk is increased to two quarts, in doses of 5 ounces ;

later on, 10 ounces. Within a week the patient has soup and a light breakfast. Later on a mutton-chop at mid-day, then thin bread-and-butter three times a day (Dr. Weir-Mitchell advised butter to be used freely). Within a fortnight the patient has three full meals daily, besides two quarts of milk. Fluid extract of malt is given before each meal.

The diet list of one of Dr. Weir-Mitchell's own patients is interesting :

October 10th.—One quart of milk in divided doses every two hours.

11th.—7 a.m., cup of black coffee. Two quarts of milk in doses of 5 ounces.

I2th to 15th.—The same.

16th.—Soup added.

17th to 18th.—Ditto.

19th to 22nd.—Patient took each day: 7 a.m., coffee; 7.30, 5 ounces of milk; 10, ditto; 11, soup; at 12, 2, and 4, milk ; 5, soup ; 6 and 8, milk ; g, soup ; 10, milk.

23rd to 27th.—Coffee, 7 a.m. ; 8, egg and bread-and-butter for breakfast ; diet as before the remainder of the day.

28th and onward.—7 a.m., coffee, iron and malt ; 8, breakfast, chop, bread-and-butter, glass and a half of milk ; 11, soup; 2, iron and malt, dinner of anything fancied, including 6 ounces of Burgundy or dry champagne, and finished with one or two glasses of milk ; 4, soup ; 7, iron and malt, bread-and-butter, fruit, and two glasses of milk ; 9, soup.

At 12 noon daily, massage for one hour ; at 4.30, electricity for one hour.

This treatment was continued to the sixth week, when soup and wine were discontinued, iron lessened to one-half, massage and electricity given on alternate days.

On the ninth week massage and electricity ceased, milk was reduced to one quart, and the patient drove out. ' The cure was complete and permanent.'

The same routine is not followed in every case. Sometimes cream is added ; at other times the milk must be thoroughly skimmed. When patients are dyspeptic, nothing but skimmed milk is given the first fortnight.

Some patients take three quarts of milk daily with ease.

They are always ready for food, no matter how much is given to them. A case given by Dr. Playfair proves how much can be consumed by these patients. For six weeks the diet was as follows : 6 a.m., 10 ounces of raw-meat soup ; 7 a.m., cup of black coffee ; 8 a.m., plate of oatmeal porridge, with a gill of cream, a boiled egg, three slices of bread-and-butter, and cocoa ; 11 a.m., 10 ounces of milk; 2 p.m., 0.5 pound of rump-steak, potatoes, cauliflower, a savoury omelette, and 10 ounces of milk ; 4 p.m., 10 ounces of milk and three slices of bread-and-butter ; 6 p.m., a cup of gravy soup ; 8 p.m., a fried sole, roast mutton (three large slices), French beans, potatoes, stewed fruit and cream, and 10 ounces of milk; 11 p.m., 10 ounces raw-meat soup.

As massage is the only exercise the patient gets, it should be vigorous. Special attention must be given to abdominal massage, to enable the digestive organs to cope with the quantities of food taken. ' Tender spots,' frequently complained of, may be avoided at first and gradually encroached on. The operator should not forget that moral massage is needed in these cases, and that the idiosyncrasy of each patient should be carefully studied. At first massage is given for twenty minutes, morning and evening ; after three days it is increased to thirty minutes, then forty minutes. By the second week it has reached one and a quarter hours twice a day.

The urine of the patient should be watched as the food is increased ; if any precipitation of urates appears, the amount of food should be lessened till the sediment disappears.

Raw-meat sandwiches are frequently ordered. To make them : Thin bread well buttered : finely shred raw lean beef, seasoned nicely with pepper and salt ; anchovy sauce or lemon-juice may be added if liked. The edges of the bread should be neatly closed that the meat may not show between.

Raw beef-juice is also often ordered.

Finely shred raw lean beef; place it in a jar with cold water and a little hydrochloric acid, in the proportions of 1 pint of water and 5 drops of acid to 1 pound of meat. Let it stand for some hours—eight to twelve—in a cool place ; then place the jar in a vessel of hot water, 100° F., for two hours ; strain through a cloth, and give as ordered. Porridge is found useful.

The rest cure is often much modified. An over-tired but not necessarily neurotic or hysterical patient is sent to bed in her own home for a month, or even two or three weeks. She is fed as above, and has massage once or twice daily ; is kept quiet, but not isolated ; is allowed to read and to receive letters, but not visitors. She sees her own family, gets up to her bath, etc., and at the end of the time returns to her duties with renewed strength and energy.