M itchell trained at the Jefferson Medical College in Philadelphia where he received his MD. In 1850, Mitchell was in charge of nervous and mental diseases at Turners Lane Hospital in Philadelphia. His experience during the American Civil War led him to develop the "rest cure," which is associated with his name.
As the author of Injuries of Nerves and Their Consequences (1872) and Fat and Blood (1877) he was a powerful advocate for the use of diet to treat both mental and physical illnesses. He advocated using diet specifically to treat "neurasthenia," a weakness of the nervous system "discovered" by the electrotherapist George
Miller Beard (1839-83) and described as early as 1869 as "The American Disease." This is the disease of urban, stressful life, the suffering of those unable to keep up with the speed of modernity, whose nervous system collapses under the strain. In order to cure this disease, rest and a fat-rich diet were necessary. As Beard noted:
Indigestion may excite and maintain neurasthenia and may result from it . . . in the body, though there may be much force in the nerve centers, yet if digestion be clogged and the waste matters are suffered to accumulate in the digestive apparatus . . . the amount of force generated and usable will be very much diminished.
Diet would cure this, and Beard advocated eating "no fruits, no vegetables, [and] no cereals except wheat" (Beard 1881: 42). Instead, he prescribed a diet of beef, mutton, lamb, fowl, eggs, and milk.
In Mitchell's America, thinness rather than obesity is the problem. In 1877, he noted in Fat and Blood and How to Make Them that " 'Banting' is with us Americans a rarely needed process, and, as a rule, we have much more frequent occasion to fatten than to thin our patients" (Mitchell 1877: 16). Fat, in his opinion, is necessary for good health:
The exact relations of fatty tissue to the states of health are not as yet well understood; but, since on great exertion or prolonged mental or moral strain or in low fevers we lose fat rapidly, it may be taken for granted that each individual should possess a certain surplus of this readily-lost material. It is the one portion of our body which comes and goes in large amount. Even thin people have it in some quantity always ready, and, despite the fluctuations, every one has a standard share, which varies at different times of life.
(Mitchell 1877: 15)
Mitchell tied the lack of "visible" body fat to the notion of an insufficiency of the nerves. It is mental illnesses, such as neurasthenia, that can result when the body becomes too thin: "I think the first thing which strikes an American in England is the number of inordinately fat people, and especially fat women . . . this excess of flesh we usually associate in idea with slothfulness" (Mitchell
1877: 15). In fact, he claims that such fat is a prophylaxis against disease: "This must make ... some difference in their relative liability to certain forms of disease" (Mitchell 1877: 15).
It is primarily women who suffer from this loss of fat and the resulting nervousness: "a large group of women, especially said to have nervous exhaustion, or who are described as having spinal irritation . . . They have a tender spine, and soon or later enact the whole varied drama of hysteria" (Mitchell 1877: 25-6). They are, he claims, "lacking in color and which had not lost flesh" (Mitchell 1877: 27). However, men too can suffer from such a debility of the nerves, specifically through traumatic experiences: "Nor is this less true of men, and I have many a time seen soldiers who had ridden boldly with Sheridan or fought gallantly with Grant, become, under the influence of painful nerve wounds, as irritable and hysterically emotional as the veriest girl," undergoing "moral degradation" (Mitchell 1877: 28). Fat men and women are mentally healthy; thin men and women suffer.
The exemplary case of treating neurasthenia though enforced inactivity and a diet of fat-rich foods is documented in Charlotte Perkins Gilman's (1860-1935) autobiographical short story "The Yellow Wallpaper" (1892). She writes of her character's malady as "but temporary nervous depression—a slight hysterical tendency" to be treated with diet, "phosphates or phosphites— whichever it is, and tonics, and journeys, and air, and exercise, and am absolutely forbidden to 'work' until I am well again" (Gilman 1997). Her husband who is also her physician suggests that " 'Your exercise depends on your strength, my dear,' said he, 'and your food somewhat on your appetite; but air you can absorb all the time' " (Gilman 1997). Gilman recounts how the boredom of inactivity and diet drives her character to the brink of true madness.
This treatment is, of course, the "rest cure." For S. Weir Mitchell, a certain amount of fat was necessary to protect the nervous system and thus the psyche from distress. He argued that "blood thins with the decrease of tissues and enriches as they increase" (Mitchell 1877: 15). And the more blood, the more psychic energy. It is a sign of "nutritive prosperity" (Mitchell 1877: 16). Such prosperity is signaled by the social station of the individual. Thus, he proposes that the "upper classes gain weight in the summer" (Mitchell 1877: 16) (and intelligence) while the working classes lose it. But it is also determined by the individual's gender. Fat men are, all in all, healthier than fat women.
Yet there is also a fat which is itself diseased. This is a fat fatter than fat. Such fat is bad; just look at the street scene in London through his eyes:
This excess of flesh we usually associate in idea with slothfulness, but English women exercise more than ours, and live in a land where few days forbid it, so that probably such a tendency to obesity is due chiefly to climatic causes. To these latter also we may no doubt ascribe the habits of the English as to food. They are larger feeders than we, and both sexes consume strong beer in a manner which would in this country be destructive of health. These habits aid, I suspect, in producing the more general fatness in middle and later life, and those enormous occasional growths which so amaze an American when first he sets foot in London. But, whatever be the cause, it is probable that members of the prosperous classes of English, over forty, would outweigh the average American of equal height of that period, and this must make, I should think, some difference in their relative liability to certain forms of disease, because the overweight of our trans-Atlantic cousins is plainly due to excess of fat.
(Mitchell 1877: 15)
The British are too fat, unlike the healthily corpulent Americans. It is a fat of excess not of health. But it too can be cured with diet, especially the consumption of large amounts of "milk is the best and most easily managed addition to a general diet" (Mitchell 1899: 119).
Mitchell was part of the growing milk cult in the nineteenth century, which saw in cow's milk the "perfect food." He presents a number of case studies such as the forty-five-year-old Mrs. P. "weight one hundred and ninety pounds, height five feet four and a half inches, had for some years been feeble, unable to walk without panting, or to move rapidly even a few steps." She is self-treating, which physicians of the nineteenth century see as dangerous: "Two years before I saw her she had been made very ill owing to an attempt to reduce her flesh by too rapid Banting, and since then, although not a gross or large eater, she had steadily gained in weight, and as steadily in discomfort" (Mitchell 1899: 231). She needs the ministrations of a physician who keeps her in bed for five weeks. Massage was used at first once daily, and after a fortnight twice a day, while milk was given, and in a week made the exclusive diet. Her average of loss for thirty days was a pound a day, and the diet was varied by the addition of broths after the third week, so as to keep the reduction within safe limits At the seventh week her pulse was 70 to 80, her temperature natural, and her blood-globules much increased in number. Her weight had now fallen to one hundred and forty-five pounds, and her appearance had decidedly improved. She left me after three and a half months, able to walk with comfort three miles. She has lived, of course, with care ever since, but writes me now, after two years, that she is a well and vigorous woman. Her periodical flow came back five months after her treatment began, and she has since had a child.
(Mitchell 1899: 231)
Thus, Mitchell's medicalization of diet can treat the nervous and the obese—and make veterans whole and women fecund.
See also Banting; Electrotherapy; Medical Use of Dieting;
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