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Silas Weir Mitchell and the “rest cure”
  1. J M S Pearce
  1. 304 Beverley Road, Analby, Hull HU10 7BG, UK;

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    Weir Mitchell1 (1829–1914), the American neurologist, renowned for his work on causalgia, was also interested in hysteria. He first encountered it in soldiers during the civil war.

    In civilian practice when faced with patients with neurosis and hysteria he developed his “rest cure”. It was based, he said, on moral and physical components described in his book Fat and blood2; the title reflected his experience that women with hysteria were often thin and anaemic. In addition to rest he insisted on removing the patient from their environment, asking them to write their life history, and using exercise, electrical stimulation, and a nutritious diet. In his hands, a rest cure was a success, perhaps owing to his patients’ immense respect and faith in him. But Weir Mitchell was wise enough to anticipate and thereby prevent what we now label illness behaviour:

    “ lie abed half the day and sew a little, and read a little, and be interesting and excite sympathy, is all very well, but when they are bidden to stay in bed a month, and neither to read, write nor sew, and to have one nurse—who is not a relative—then rest becomes for some women a rather bitter medicine and they are glad enough to accept the order to rise and go about when the doctor issues a mandate which has become pleasantly welcome and eagerly looked for.”1

    Attending a lady, sick unto death, he dismissed his assistants from the room then soon left himself. Asked of her chances of survival he remarked:

    “Yes she will run out of the door in two minutes; I set her sheets on fire. A case of hysteria.”

    His prediction thankfully proved correct.

    “I urged, scolded and teased and bribed and decoyed along the road to health; but this is what it means to treat hysteria.”

    Weir Mitchell penned several classic books and papers.3,4 He invented the term causalgia for the intractable pain consequent upon nerve injury. In Reflex paralysis5 he described the sudden weakness of the limbs on the side opposite to forebrain injury, thus anticipating the lateralisation of motor function by Fritsch and Hitzig by five years.

    He studied postparalytic chorea, erythromelalgia (Weir Mitchell’s disease), and deduced that the cerebellum augments and reinforces movement.