Monday, May 12, 2008

Fat and Blood, Chapter VII: Electricity (S. Weir Mitchell)

S. Weir Mitchell

Webmaster's Notes:

Fat and Blood: An Essay on the Treatment of Certain Forms of Neurasthenia and Hysteria
, by S. Weir Mitchell, has been included on this site because Dr. Mitchell's famous "Rest Cure" was instrumental in changing the course of Charlotte Perkins Gilman's life, and, indeed, the infamous cure was cited several times by Gilman.

Due to formatting difficulties, the charts have been converted to graphic form; the original text is presented here, but it has been "whited" out. To view the original text, simply highlight the whited out spaces.



Electricity is the second means which I have made use of for the purpose
of exercising muscles in persons at rest. It has also an additional
value, of which I shall presently speak.

In order to exercise the muscles best and with the least amount of pain
and annoyance, we make use of an induction current, with interruptions
as slow as one in every two to five seconds, a rate readily obtained in
properly-constructed batteries.[24] This plan is sure to give painless
exercise, but it is less rapid and less complete as to the quality of
the exercise caused than the movements evolved by very rapid
interruptions. These, in the hands of a clever operator who knows his
anatomy well, are therefore, on the whole, more satisfactory, but they
require some experience to manage them so as not to shock and disgust
the patient by inflicting needless pain. The poles, covered with
absorbent cotton well wetted with salt water, which may be readily
changed, so as not to use the same material more than once, are placed
on each muscle in turn, and kept about four inches apart. They are moved
fast enough to allow of the muscles being well contracted, which is
easily managed, and with sufficient speed, if the assistant be
thoroughly acquainted with the points of Ziemssen. The smaller electrode
should cover the motor-point and the larger be used upon an indifferent
area. After the legs are treated, the muscles of the belly and back and
loins are gone over systematically, and finally those of the chest and
arms. The face and neck are neglected. About forty minutes to an hour
are needed; but at first a less time is employed. The general result is
to exercise in turn all the external muscles.[25]

No such obvious and visible results are seen as we observe after
massage, but the thermal changes are much more constant and remarkable,
and show at least that we are not dealing with an agent which merely
amuses the patient or acts alone through some mysterious influence on
the mental status.

A half-hour's treatment of the muscles commonly gives rise to a marked
elevation of temperature, which fades away within an hour or two. This
effect is, like that from massage, most notable in persons liable to
fever from some organic trouble, and it varies as to its degree in
individuals who have no such disease.

The first case, Miss B., æt. 20, is an example of tubercular disease of
the apex of the right lung. She had a morning temperature of 98-1/2° to
99-1/2°, and an evening temperature of 100° to 102°.

Electricity was used about 11 o'clock daily, with these results:
Before Electricity. After Electricity.

November 25 99 99-3/5
" 27 97-3/5 100
" 28 98 99
" 29 98-4/5 99-4/5

December 2 100-1/5 101-3/5
" 4 99-1/5 100-1/5
" 5 99-2/5 99-1/5

Mrs. R., æt. 40, the next case, was merely a rather anæmic, feeble, and
thin woman, who for years had not been able to endure any prolonged
effort. She got well under the general treatment, gaining thirteen
pounds on a weight of ninety-eight pounds, her height being five feet
and one inch. The facts as to rise of temperature are most remarkable,
and, I need not say, were carefully observed.

Temperature taken in the mouth while at rest in bed.

Before Electricity. After Electricity.

April 2 98-2/5 98-4/5
" 3 98-1/5 98-2/5
" 4 98-1/5 98-2/5
" 5 98 98-3/5
" 6 97-9/10 98-7/10
" 7 98 98-5/10
" 8 98 98-3/5
" 9 98 98-1/10
" 10 98-2/5 98-3/5
" 11 98-5/10 98-7/10
" 12 98-3/5 99-1/10
" 13 98-1/5 99-5/10
" 14 98-2/5 99-1/5
" 16 98-4/10 99-1/10
" 17 98-5/10 99-2/10
" 18 98-7/10 99-1/10 One hour later, 99-1/10
" 19 98-9/10 99-3/10 " " " , 98-4/5

Before Electricity. After Electricity.

April 20 99 99-1/10

" 21 98-9/10 99-2/10
Menstrual period.

" 30 98-3/5 98-3/5

May 1 98 98-5/10

" 2 98 98-3/10

The third case, Miss M., æt. 33, was that of a pallid woman, the
daughter of a well-known physician in the South. She suffered for six
years with "nervous exhaustion," headaches, pain in the back, intense
depression of spirits, nausea, and repeated attacks of hysteria. She
slept only under anodynes, and used stimulants freely. Under the use of
rest and the adjuvant treatment described, Miss M. made a thorough
recovery, and was restored to useful active life.

Miss M. Thermometer held in mouth.

Before Electricity. After Electricity.

May 14 99-1/10 99-1/10 } Menstruating; general
} faradization only.
" 15 99 99-1/5 }

" 16 99-1/5 99-1/5 Gen'l faradization and limbs.

" 17 98-4/5 99-1/5

" 18 98-4/5 99-1/5

" 19 98-1/5 98-4/5

" 21 98-3/5 99

" 22 98-4/5 99-1/10

Before Electricity. After Electricity.

May 25 98-1/10 98-4/10

" 26 98-1/10 99-1/10

" 29 98-3/5 99

" 30 98-5/10 99-1/10

" 31 98-9/10 99-1/10

Mrs. P., æt. 38, was a rather nervous woman, easily tired, but not
anæmic and not very thin. She improved greatly under the treatment.
Before Electricity. After Electricity.

January 27 98-3/5 99-1/5 Thermometer in axilla ten

" 29 98-2/5 99-1/5 minutes before and after.

" 30 99-1/5 99-3/5

" 31 98-4/5 99-2/5

February 1 99 99-2/5
Menstrual period.

February 8 98-2/5 99-1/5

" 9 98-3/5 99

" 10 98-2/5 99

" 12 98-1/5 99-3/5

" 13 98-2/5 99

" 14 98-2/5 98-3/5

" 15 98-2/5 98-4/5

" 19 99 98-2/5

" 20 98 99

" 23 98-3/5 99-4/5 Thermometer in mouth five

" 24 99 99-2/5 minutes before and after.

" 27 99-1/5 99-3/5

" 28 98-4/5 99-4/5
Menstrual period.

Menstrual period.

Before Electricity. After Electricity.

March 13 99 99-2/5

" 14 98-4/5 98-4/5

" 15 99 99-1/5

Miss R., æt. 27, was a fair case of hysterical conditions; over-use of
chloral and bromides; anorexia and loss of flesh and color.

Thermometer in mouth.

Thermometer in mouth.

Before Electricity. After Electricity.

May 15 100 100 }
} General faradization
" 16 100 100 } for fifteen minutes.
" 17 100-1/5 100-2/5 }

" 18 98-2/5 98-3/5 } General faradization,
} fifteen minutes, also of
" 19 99-4/5 100-1/10 } arm muscles, twenty minutes.

May 20 100-1/10 100
General faradization, ten
" 22 99-2/5 99-3/5 minutes; arms and legs
twenty minutes.
" 26 99-1/10 99-2/10

" 27 99-3/10 99-4/10

" 28 99-2/5 99-2/5

" 29 99-3/10 99-3/10

" 30 99-1/10 99-4/10

" 31 99-1/10 99-2/10

June 2 99-3/5 99-4/5

" 4 99-5/10 99-6/10

" 6 99-3/10 99-5/10

" 7 99-3/10 99-5/10

I have given these full details because I have not seen elsewhere any
statement of the rather remarkable phenomena which they exemplify. It
may be that a part at least of the thermal change is due to the muscular
action, although this seems hardly competent to account for any large
share in the alteration of temperature, and we must look further to
explain it fully. No mental excitement can be called upon as a cause,
since it continues after the patient is perfectly accustomed to the
process. I should add, also, that in most cases the subject of the
experiment was kept in ignorance of the fact that a rise of the
thermometer was to be expected. Is it not possible that the current even
of an induction battery has the power so to stimulate the tissues as to
cause an increase in the ordinary rate of disintegrative change? Perhaps
a careful study of the secretions might lend force to this suggestion.
That the muscular action produced by the battery is not essential to the
increase of bodily heat is shown by the next set of facts to which I
desire to call attention.

Some years ago, Messrs. Beard and Rockwell stated that when an induced
current is used for fifteen to thirty minutes daily, one pole on the
neck and one on either foot, or alternately on both, the persistent use
of this form of treatment is decidedly tonic in its influence. I believe
that in this opinion they were perfectly correct, and I am now able to
show that, when thus employed, the induced current causes also a decided
rise of temperature in many people, which proves at least that it is in
some way an active agent, capable of positively influencing the
nutritive changes of the body.

The rise of temperature thus caused is less constant, as well as less
marked, than that occasioned by the muscle treatment. I do not think it
necessary to give the tables in full. They show in the best cases, rises
of one-fifth to four-fifths of a degree F., and were taken with the
utmost care to exclude all possible causes of error.

The mode of treatment is as follows: At the close of the
muscle-electrization one pole is placed on the nape of the neck and one
on a foot for fifteen minutes. Then the foot pole is shifted to the
other foot and left for the same length of time.

The primary current is used, as being less painful, and the
interruptions are made as rapid as possible, while the cylinder or
control wires are adjusted so as to give a current which is not

It is desirable to have electricity used by a practised hand, but of
late I have found that intelligent nurses may suffice, and this, of
course, materially lessens the cost. In very timid or nervous people, or
those who at some time have been severely "shocked" by the application
of electricity in the hands of charlatans, it is common to find the
patient greatly dreading a return to its use. In this case, if the
battery be started and the poles moved about on the surface as usual,
but without any connection being made, one of two things will
happen,--either the patient will naturally find it very mild, and will
submit fearlessly to a gentle and increasing treatment, or else her
apprehensions will so dominate her as to cause her to complain of the
effects as exciting or tiring her, or as spoiling her sleep. A few words
of kindly explanation will suffice to show her how much expectation has
to do with the apparent results, and she will be found, if the matter be
managed with tact, to have learned a lesson of wide usefulness
throughout her treatment.

However, there are occasional, though very rare, cases in which it is
impossible to use faradism at all by reason of the insomnia and
nervousness which result even after very careful and gentle application
of the current. On the other hand, some patients find the effect of the
electric application so soothing as to promote sleep, and will ask to
have it repeated or regularly given in the evening.

I have been asked very often if all the means here described be
necessary, and I have been criticised by some of the reviewers of my
first edition because I had not pointed out the relative needfulness of
the various agencies employed. In fact, I have made very numerous
clinical studies of cases, in some of which I used rest, seclusion, and
massage, and in others rest, seclusion, and electricity. It is, of
course, difficult, I may say impossible, to state in any numerical
manner the reason for my conclusion in favor of the conjoined use of all
these means. If one is to be left out, I have no hesitation in saying
that it should be electricity.


[Footnote 24: Most induction batteries are without any arrangement for
making infrequent breaks in the current.]

[Footnote 25: In the extreme constipation of certain hysterical women,
good may be done by placing one conductor in the rectum and moving the
other over the abdomen so as to cause full movement of the muscles. This
means must at first be employed cautiously, and the amount of
electricity carefully increased. It is doubtful if any movement of the
intestinal muscle-fibres is thus caused, but that it is a useful method
of stimulation in obstinate cases may be taken as proved.]








Copyright, 1877, by J.B. LIPPINCOTT & CO.

Copyright, 1883, by J.B. LIPPINCOTT & CO.

Copyright, 1891, by J.B. LIPPINCOTT COMPANY.

Copyright, 1897, by J.B. LIPPINCOTT COMPANY.

Copyright, 1900, by J.B. LIPPINCOTT COMPANY.

Copyright, 1905, by S. WEIR MITCHELL.


Etext from Project Gutenberg.

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