When, about 25 years ago, Weir Mitchell and Playfair introduced a systematic fattening cure as an important means of treatment in hysteria and neurasthenia, rest and isolation were at the same time included in the therapeutic program. We concede now-a-days that in numerous cases these accessory means are needed; for the physical condition of the patient frequently demands their employment. In the meantime fattening cures have been introduced in a much wider variety of disorders, so that to-day they are employed not only in the treatment of nervous disorders that are closely related to psychoses, but also in diseases in which the sole aim of the fattening cure is to strengthen the organism as a whole, and in this way to favorably influence and support certain organs whose function has become impaired. Nevertheless, a rest-cure (usually implying several weeks in bed) is generally included both by the laity and by physicians in the idea of a fattening cure; the underlying conception being that the rest of the muscular apparatus by depressing oxydative processes to the lowest conceivable minimum favors a correspondingly increased deposit and storage of the surplus pabulum administered. As a prototype and example the success of farmers in the fattening of cattle and poultry by this means is often quoted.

The underlying principle is correct, but its general application wrong. One can exclude cases that on account of nervous diseases or disorders about other organs (for instance, ulcer of the stomach, tuberculosis of the lungs) require a prolonged rest-cure. Even in the absence of such definite indications one is justified, naturally, in the beginning of any fattening cure in prescribing absolute rest (for a few days to a week) if for no other reason than that it is much easier in this way to accustom the patient to strict regularity in feeding; besides one can under such conditions more readily apply moist, warm or cold abdominal compresses that are often necessary to relieve certain subjective disturbances appearing in persons with hyperesthetic digestive organs. As soon as feasible, however, and as soon as, with the aid of the rest-cure, the first 2 to 3 kg have been gained, muscular exercise should be instituted. Massage is quite useless, for it does not sufficiently strengthen the muscles. Massage may be indicated only in the intermediary transition stage of the treatment. Active muscular labor is what is required, for only by this means can the protoplasm-forming forces become mobilized. This point has already been thoroughly discussed.

It is true that by muscular exercise a part of the flesh that has been gained is sacrificed and that the risk is always incurred of restricting the total gain in weight. As a rule, however - provided muscular exercises are not begun too soon and do not exceed in the total labor performed the actual capacity of the muscular apparatus - a very welcome increase in the appetite will be produced causing a greater ingestion of food that more than overbalances the loss of energy resulting from the physical labor. I have frequently ordered patients undergoing a fattening cure to exercise from one hour from the second week of the treatment on; and beginning with the third week to climb to an elevation each day of from 150 to 250 meters; rowing and swimming exercises are also often instituted. The ultimate gain in weight is by no means less than the gain that would have been accomplished as an optimum had the rest-cure plan been persisted in. Another great advantage is gained hereby, namely, that the patients are not, at the termination of the treatment, merely fat, but actually stronger in muscle development, and find themselves in a good state of nutrition, so that they can resume their daily life with greater confidence in themselves and with an assured and definite working capacity.

From the same standpoint is is advisable to employ hydrotherapy as an adjuvant to the treatment as early as possible; the methods to be employed, however, should not be of a softening character, as is so often unfortunately the case, nor should their effect be merely suggestive (radium baths, oxygen baths, irradiation with the different colors of the rainbow, etc.), but really hardening methods that actually have a tendency to exercise the depressed functions back to normal. I cordially agree in this respect with Winternitz, who has frequently emphasized these points.

Together with the new-formation of muscle tissue that is forced in this way a regeneration of the blood is generally witnessed. Certain other adjuvants to the treatment may nevertheless be required to fulfill this latter purpose. Thus the patients during their hours of rest should be encouraged to remain out of doors. I have adopted this plan, that has been so popular in the case of consumptives for a long time, in the case of subjects undergoing a simple fattening cure, and with the best results even during the winter months in Germany. Occasionally one cannot get along without certain drugs that are intended to stimulate blood formation. Arsenic, unless one is dealing with chlorosis, by all means deserves the preference over iron; at the same time the exaggerated use of arsenic preparations, in particular the injection of cacodylates that are now-a-days so universally employed, should be energetically condemned. Unless there is present an anaemia due to relaxation of the bone marrow function, such arsenic treatments are essentially without value. We have actually arrived at a place where in simple fattening cures an injection of cacodylate is valued more highly than a beef steak.

In another place reference was made to the fact that the glandular organs must be considered storehouses of protoplasm in the same sense as the muscles and the blood. No particular attention, however, need be bestowed upon these organs during a fattening cure. For with the introduction, digestion and assimilation of more food, the activity of the digestive and excretory glands is automatically increased, and this increased labor exercises and strengthens these parts. The greatest benefits accrue primarily to the gastro-intestinal tract, so that we often witness an improvement in the absorptive and assimilative powers of the digestive organs as the fattening cure progresses. Not only is the glandular apparatus of the digestive tract favorably affected, but the muscle tonus and the motor power of the intestine become increased. How often do we witness a disappearance of gastric atony and of sluggishness of the bowel function in the course of a fattening cure. Under certain circumstances, of course, the increased labor that has to be imposed upon certain organs in the course of a fattening cure may force an abandonment of any attempt at fattening, or may necessitate a very particular selection of the diet, as, for instance, in the case of dis eased kidneys.