In the late 19th century, S. Weir Mitchell's "Rest Cure" was all the rage among upper-middle-class American women. It was a treatment for a nervous condition called neurasthenia, and consisted of seclusion, rest, overfeeding, electric stimulation and massage.

Patients were not allowed to read, write or otherwise strain themselves for the duration of the treatment, which went on for several weeks. Massage was used to diminish some of the "evil and pernicious results" of the prolonged rest and seclusion that were considered essential to the treatment (Dowse, 1906).

The Rest Cure, later called the Weir Mitchell Treatment, was considered a miraculous cure by some, and was successful in enough cases to gain national and international acclaim. It was also defamed by feminist writer Charlotte Perkins Gilman as leading to insanity. If nothing else it created quite a stir in its time.

Figure 1. Massage of the arm, as in the Rest Cure, c. 1890

The Rest Cure is important in the history of medical massage as an early example of its use in psychiatric care in Western medicine. It drew the attention of the medical community in America and Europe to the potential of massage in the treatment of mental and emotional disorders. And even though our understanding of the disorders addressed by the Rest Cure has changed dramatically in the past century, the benefits of massage within the context of the treatment are still evident.

Thomas S. Dowse, a prominent physician in London, credits the Weir Mitchell Treatment with giving rise "to a large following of people, calling themselves masseurs and masseuses," adding that "the physician in truth cannot possibly do without them." Dowse is also one of the early voices advocating for better training and standards for massage practitioners (1906, p. 10).

The Rest Cure is best understood in the context of the times (i.e., Victorian America, 1870-1910). Urban living, the increasing number of office and "brain" workers, ideas about women's health and disease, and the early feminist movement all have a part to play in the story of S. Weir Mitchell's treatment for the new and peculiarly urban condition called neurasthenia.

Neurasthenia
This is a term no longer in scientific use. Neurasthenia was a catchall word for what was probably a number of different conditions with similar symptoms, including chronic fatigue, weakness, generalized aches and pains, loss of appetite and listlessness. It was thought to result from exhaustion of the brain and nervous system.

Neurasthenia was originally associated with men in urban areas who had office jobs and did "brain-work" in business, literary or professional occupations. It was a malady associated with late 19th and early 20th century urbanization. Major symptoms of the conditions were "disinclination for mental labor" and "disturbances of the heart's action, the functions of the stomach, liver, intestinal canal, etc."

To modern ears, it sounds like stress and burnout. Neurasthenia was considered by many to be a sign of advancing civilization and of superiority of men who rose above manual labor (Green, 1886).

It was a different story for women. At a time when a woman's health and destiny were defined by her reproductive system, neurasthenia was a sign that something had gone terribly wrong in the natural order. The symptoms, which in men were considered a badge of honor, in women pointed to overtaxing of delicate sensibilities. For women, engaging in intellectual pursuits like reading and writing, studying and business were considered unnatural, unhealthy and a danger to the future of civilization.

"The message was clear and full of foreboding. Only if women refrained from those activities, which might challenge the role of men in the power structure of the nation, would they be able to fulfill the destiny and promise of America" (Green, 1983, p. 138).

In 1889, Dr. Arabella Kenealy proposed that boredom rather than intellectual work was the cause of women's neurasthenia. She observed that when middle class and wealthy women were relieved of their chores by new household conveniences, they became bored (Green, 1983). Add to that the growing number of women who received college education only to find their sphere restricted to husband and home, and the potential for "nervous" disorders like chronic depression multiplies.

Mitchell described the targeted population for his Rest Cure as "chiefly women of the class well known to every physicianÑnervous women, who as a rule are thin and lack blood. Most of them have been such as had passed through many hands and been treated in turn for gastric, spinal, or uterine troubles, but who remained at the end as at the beginning, invalids, unable to attend to the duties of life, and sources alike of discomfort to themselves and anxiety to others" (Mitchell, 1877).

Treatment for neurasthenia in women focused on rest and control of emotions that might drain her nervous energy. Popular treatments in the 1870-1880s included fresh air and exercise, low-voltage electricity, and various tonics, elixirs and patent medicines. The patent medicines, many of which contained a considerable amount of alcohol, and some with opium, did more harm than good and were later associated with the cause rather than the cure of the condition (Stage, 1979).

Victorian America was also a time when it was fashionable for women to look and act sickly and weakÑthe "tubercular look." Neurasthenia was elevated to "a prestigious malady of bourgeois society." It was a fashionable disease, and a badge of class and status. Women are said to have compared symptoms, doctors, health spas and treatments. It was in this climate that S. Weir Mitchell, a prominent Philadelphia physician, introduced the Rest Cure.

S. Weir Mitchell (1829-1914)
Silas Weir Mitchell was born in Philadelphia in 1829. He was of Scottish descent, and a third-generation doctor. He completed a two-year course at the Jefferson Medical College (Philadelphia) in 1850, and was a contract surgeon for the Union Army during the Civil War, working in Philadelphia hospitals. After the war, Mitchell became a physician at the Orthopedic Hospital and Infirmary for Diseases of the Nervous System. He wrote well-received medical articles such as "Injuries to the Nerves and Their Treatment" (1872), "Wear and Tear" (1873), and of primary interest to this article, the book Fat and Blood and How to Make Them (1877), a treatise that introduced his famous Rest Cure.

Mitchell was said to be one of the great neurologists of the 19th century. He even attracted the attention of Sigmund Freud, who occasionally reviewed Mitchell's writing, including "The Treatment of Certain Forms of Neurasthenia and Hysteria" (1887). Freud is said to have advocated the Rest Cure with notable modifications, especially regarding seclusion and absolute rest (Lovering, 1971).

Mitchell was also a well-known poet and novelist. He wrote several stories and serial novels for the Atlantic. His popular novels include Hugh Wynne (1896), Circumstance (1901), Constance Trescot (1905) and Westways (1913), all related to the Civil War and Reconstruction. Mitchell was at home in literary circles and was on familiar terms with some of the leading writers, historians and artists of his dayÑboth men and women. One biographer suggested that he sought out the feminine reaction to his fiction, and was undoubtedly influenced to some extent by the advice of his women friends (Lovering, 1971).

In 1874, Mitchell married his second wife, Mary Cadwalader, a member of the Philadelphia aristocracy. Perhaps it was his familiarity with Philadelphia high society and literary circles that sparked his interest in treating nervous disorders of middle class and wealthy women. Given the time and place, no doubt many of his and his wife's circles of friends exhibited symptoms of neurasthenia.

Figure 2. Massage of the abdomen, as in the Rest Cure, c. 1890

The Rest Cure
The Rest Cure was a combination of treatments already used for cases diagnosed as neurasthenia minus harmful patent medicines. It is described in Mitchell's book with the curious title, Fat and Blood and How to Make Them, published in 1877.

"For some years I have been using with success, in private and in hospital practice, certain methods of renewing the vitality of feeble people by a combination of entire rest and of excessive feeding, made possible by passive exercise obtained through the steady use of massage and electricity" (Mitchell, 1877, p. 7).

Fat actually referred to weight gain by the emaciated patient, and blood generally referred to the development of strength and vitality of a feeble individual.

Physicians who later adopted the Weir Mitchell Treatment refined its use, modifying its application to the individual receiving treatment. Over a period of 30 years, the field of psychology progressed, and greater distinctions were made between patients and their symptoms. The treatment was modified accordingly. In 1906, Dowse identified three types of patients for whom he would prescribe modified versions of the Weir Mitchell Treatment.

"The first is the thin, emaciated, bed-ridden, helpless and hopeless invalid. The second is the thin, wiry, anxious, exhausted, but acutely lively invalid, who is constantly aiming to do something, but fails to do anything, because she becomes weary and exhausted with any attempt at prolonged effort, and suffers habitually from headaches. The third is the fat, excessively pale invalid, who fails to make blood, whose muscles are flabby, and who is always tired and constantly complaining of weariness and inability to do anything with sinkings, sighings, and yawning in superabundance" (Dowse, 1906, p. 158).

Seclusion and rest are perhaps the most controversial parts of the Rest Cure, especially when taken to the extreme. In its most dogmatic form, rest was taken to mean complete bed rest with no reading, writing, or talking to friends or family. Charlotte Perkins Gilman vilified this aspect of the Rest Cure in her 1892 short story, "The Yellow Wallpaper."

"The Yellow Wallpaper" describes the ordeal of a woman, whose doctor-husband confines her to an attic nursery keeping her in complete seclusion and prohibiting any intellectual activity. She keeps a diary that chillingly documents her descent into insanity.

Gilman later explained that she herself had suffered from "a severe and continuous nervous breakdown tending to melancholiaÑand beyond." After three years in this state, she visited "a noted specialist in nervous diseases, the best known in the country," who was presumably Weir Mitchell himself. She was put to bed for the Rest Cure and after a short time released from his care with the admonition "to live as domestic a life as far as possible," and "never to touch pen, brush, or pencil again." It was 1887.

"Then using the remnants of intelligence that remained, and helped by a wise friend, I cast the noted specialist's advice to the winds and went to work again É ultimately recovering some measure of power" (Gilman, 1913).

Speculation regarding why Mitchell insisted on seclusion and complete rest during the first part of Rest Cure runs the gamut from a sincere belief that intellectual activity was detrimental to the health of women, to a more strategic motive. He himself stated that "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" (Mitchell, 1877, p. 41). Of course, this tactic would only work if the woman was affecting illness, and had no serious condition.

Figure 3. Electricity used to restore vitality, via Electreat device, c. 1920

The Rest Cure was seen by some as cruel and controlling, and had many early feminists up in arms. In any case, it evolved with the times so that even Mitchell himself reportedly admitted to friends that he altered his treatment, especially after reading "The Yellow Wallpaper." In some cases, isolation and bed rest were dispensed with altogether.

Electricity And Nutrition
In a lecture on the Weir Mitchell Treatment, Dowse describes the use of electricity or faradization three to five weeks into the treatment. For example, a flat electrode might be used along the spinal muscles to excite motor points and cause muscle contraction, much the same as electrical stimulation is used today.

Battery devices also were used to run a weak electrical current through a part of the body.
"I have in these cases without any doubt obtained excellent results from the combined faradic and galvanic currents used about the fifth week of treatment. I employ a strong salt-and-water foot bath the positive pole being applied to the nape of the neck, the operation lasting about ten minutes, alternating the current some dozen times" (Dowse, 1906, p. 158).

Electricity was thought to raise the temperature of the body, as well as stimulate the muscles, and increase overall vitality.

In the original Rest Cure, the plan was to overfeed or force-feed thin emaciated patients. As the treatment evolved over the decades, good nutrition or being well fed was recognized as more important. Dowse observes that "thorough and complete feeding is, of course, in all cases absolutely necessary, but gluttonizing is not essential." He notes that each case needs to be assessed individually to determine the actual nutritional needs of the patient (1906).

Massage In The Rest Cure
Mitchell describes the regimen of massage in some detail in his 1877 treatise, seen on the opposite page. After a few days on a milk diet, the patient begins to receive daily massage, a routine that lasts for about six weeks. Massage is considered passive exercise to keep the patient's condition from deteriorating while on bed rest, and preparing them for the active exercise of walking. In the seventh week massage is given on alternate days, and tapers off as the person becomes more active.

Mitchell emphasizes what he believes to be the beneficial effects of massage for a patient on absolute rest, including stimulating secretions of the skin, firming up flabby muscles, increasing blood flow, reduction of soreness, and a "general sensation of comfort and ease [that] follows the later treatments." Mitchell valued the observations about his patients by "practiced manipulators," and found that "their daily familiarity with every detail of the color and firmness of the tissues is often of great use to me" (1877).
 

How Massage Was Applied The following is an excerpt from Chapter V of Mitchell's 1877 book, Fat and Blood and How to Make Them "An hour is chosen midway between two meals, and, the patient lying in bed, the manipulator starts at the feet and gently but firmly pinches up the skin, rolling it lightly between his fingers and going carefully over the whole foot, then the toes are bent and moved about in every direction, and next with the thumbs and fingers the little muscles of the foot are kneaded and pinched more largely, and the inter-osseous groups worked at with fingertips between the bones. At last the whole tissues of the foot are seized with both hands and somewhat firmly rolled about. Next the ankles are dealt with in like fashion, all the crevices between the articulating bones being sought out and kneaded, while the joint is put in every possible position. The leg is next treated, first by surface-pinching, and then by deeper grasping of the areolar tissue, and last by industrious and deeper pinching of the large muscle masses, which for this purpose are put in a position of the utmost relaxation. The grasp of muscles is momentary, and for the large muscles of the calf and thigh both hands act, the one contracting as the other loosens its grip. In treating the firm muscles of the front of the leg, the fingers are made to roll the muscle under the cushions of the fingertips. At brief intervals the manipulator seizes the limb in both hands and lightly runs the grasp upwards, so as to favor the flow of venous blood currents, and then returns to kneading of the muscles. Figure 4. Massage of the leg, as in the Rest Cure, c. 1890 "The same process is carried on in every part of the body, and special care is given to the muscles of the loins and spine, while usually the face is not touched. The belly is treated by pinching the skin, then by deeply grasping and rolling the muscular walls in the hands, and at last the whole belly is kneaded with the heel of the hand in a succession of rapid, deep movements, passing around in the direction of the colon É At first or a few sittings they are to be very gentle, but by degrees they may be made more rough, and if the masseur [or masseuse] be a good one it is astonishing how much strength may be used without hurting the patient. "The early treatment should last half an hour and should be increased by degrees to an hour, after which should follow an hour of absolute rest. "After the first few days I like the rubber to keep the part constantly lubricated with cocoa-oil, which is agreeable in odor, and which keeps well even in warm weather if a little lime-water be left standing on the top of it. Vaseline is also a good lubricant, and both of these agents make the skin smooth and soft and supple. As soon as a part is manipulated it should be at once wrapped up..... "...The daily massage is kept up through at least six weeks, and then, if everything seems to me to be going along well, I direct the rubber to spend half of the hour exercising the limbs as a preparation for walking. This is done after the Swedish plan, by making movements of flexion and extension, which the patient is taught to resist. "At the seventh week the treatment is used on alternate days, and is commonly laid aside when the patient gets up and begins to move about."

The Legacy
The Rest Cure ran its course of popularity in the early 20th century. But perhaps its lasting legacy for us was the recognition of the potential of massage as an important part of the mental and emotional healing process. It is not an impossible leap to believe that the women who received massage as part of the Rest Cure found relief not only on the physical level, but found emotional healing as well. We are well aware today of the mind-body continuum and the healing effects of touch. Thomas Dowse had a glimpse of this connection almost 100 years ago.

"Now, I have told you more than once with reference to massage, that just as we build up the physical side of the human body ... so we also improve and restore the integrity and the normal balance which should exist between the mind on the one hand, and the body on the other, so that by our mechanical manipulations upon the physical side of our existence we also hope to restore derangements in the mental processes which are so intimately connected therewith" (1906, p. 146).

More than 125 years ago, S. Weir Mitchell and his famous Rest Cure helped raise awareness about the benefits of massage in the treatment of mental and emotional problems. This story is part of our heritage.

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Patricia J. Benjamin, Ph.D., is co-author of Tappan's Handbook of Healing Massage Techniques and Understanding Sports Massage. She has been writing and teaching about the history of massage therapy since the early 1980s. She is currently academic dean of the Chicago School of Massage Therapy, and can be reached by telephone at: 773-477-9444, or via E-mail at: pjb@csmt.com.

Bibliography

Dowse, T. S. "Lecture VII: The Weir-Mitchell Treatment." Lectures on Massage & Electricity in the Treatment of Disease. Bristol: John Wright & Co., 1906.

Gilman, C. P. "Why I Wrote The Yellow Wallpaper." The Forerunner. October, 1913.

Green, H. The Light of the Home: An Intimate View of the Lives of Women in Victorian America. New York, New York: Pantheon Books, 1983.

Green, H. Fit For America: Health, Fitness, Sport & American Society. New York, New York: Pantheon Books, 1986.

Lovering, J. P. S. Weir Mitchell. New York, New York: Twayne Publishers, Inc., 1971.

Mitchell, S. W. Fat and Blood and How to Make Them. Philadelphia: J.B. Lippincott & Co., 1877.

Stage, S. Female Complaints: Lydia Pinkham and the Business of Women's Medicine. New York, New York: W.W. Norton & Company, 1979.

Sampson, C. M. A Practice of Physiotherapy. St. Louis: C.V. Mosby Company, 1926.