Fat and Blood: An Essay on the Treatment of Certain Forms of Neurasthenia and Hysteria

Mitchell, S. (Silas) Weir

Primary Category: Literature / Nonfiction

Genre: Essay

Annotated by:
Willms, Janice
  • Date of entry: Mar-14-1999
  • Last revised: Aug-21-2006


Shortly after the American Civil War, neurologist S. (Silas) Weir Mitchell became interested in a certain group of women, whom he describes as "of a class well known to every physician,--nervous women, who, as a rule, are thin and lack blood." Mitchell’s basic premise was that these women, largely between the ages of 20 and 30, have lost their vitality as a result of some form of prolonged strain--which has caused them to become thin, of insufficient blood, and unable to perform their regular duties.

In his long essay, essentially a compilation of case studies, he further characterizes these patients and outlines the treatment which he found to be unfailingly successful in returning them to normal activity. The treatment he utilized had the following essentials: seclusion and rest; massage; electric stimulation, a high-fat and high-calorie diet. His patients were not allowed to see their families, nor to read, write or otherwise strain themselves. The average duration of therapy was six weeks, usually carried out in an institution or private retreat.

Of interest is the single male who Mitchell felt met the criteria for his treatment plan. This patient, who had some (to the modern reader) lung findings suggestive of tuberculosis, allegedly was cured after three months of bed rest and frequent feedings.


Mitchell’s "rest cure" became the rage for upper class American women who did not seem to be thriving in the last quarter of the nineteenth century. Apparently it was also adopted by some in England, and in a limited way by Sigmund Freud. This bit of medical history is of interest in understanding and interpreting the diagnosis of hysteria in the latter part of the nineteenth century.

It also raises some contemporary issues about certain poorly understood disease categories that have been fairly recently considered in the late twentieth century--largely ailments of women which defy full classification and explanation. The work itself is a fine example of case presentation and discussion as it was regularly presented to the public as well as professional colleagues in the era of Mitchell’s practice.


Earlier editions listed in the Library of Congress catalog: 1884 (3rd ed.) and 1898 (7th ed.). The 1907 edition is the 8th.


J. B. Lippincott

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