In many cases of hysteria diet need not be prescribed. This is also true of some cases of neurasthenia. When either malady is persistent, malnutrition, a lessened or capricious appetite, and slow and sometimes painful digestion are noticeable symptoms. Extreme emaciation and feebleness are prominent in severe cases.

When a physician is consulted at the onset of the disease, he should so guide the patient that loss of flesh and strength will not take place. Nothing helps so much to restore those who are neurasthenic to health as to place them where they are free from excitement or depression, and where they can regain good flesh and strength. It is often best to remove them from the care of friends and family for several weeks. The rest cure devised by Weir Mitchell, which is surer to restore them to health than any other, is used, either as recommended by him or in a modified form, by most physicians. Mild cases of neurasthenia and those of recent origin can often be cured by travel. A voyage at sea for those who do not suffer much from seasickness will afford mental and physical rest, as well as diversion. Travel among strangers, in the midst of novel and interesting sights, will stimulate patients to exercise in the open air, will improve appetite and digestion, divert thoughts from business or other worry, and promote sleep.

When the rest cure must be enforced, the patient should be removed from home, and no friends and relatives nor any but agreeable news allowed for several weeks to come to her. As she must be in the company of her nurse for a considerable time, one should be selected who will be agreeable to her. The patient should keep her bed for six weeks at least, leaving it only to use the vessel. It is best to begin the milk diet gradually. If a patient does not like milk, it should be given in doses of one or two ounces every two hours. Sometimes it is best to begin with skimmed milk, to use even smaller doses, and to permit the use of a little other food at meal-times. In two or three days larger amounts can readily be taken. As much as two quarts of milk ought to be drunk in twenty-four hours. In some cases food should be given even at night, as often as every three or four hours. As a rule, an exclusive milk diet quickly causes dyspeptic symptoms to disappear, but constipation persists or develops. It must be corrected by the administration of a mild laxative at night. A cup of coffee without sugar, in the morning, sometimes helps to move the bowels. Massage should be practised each day, usually at noon, and should be given so as to help in preventing constipation. At first it must be applied gently for only fifteen or twenty minutes, the abdomen being rubbed carefully, especially along the course of the colon. By degrees a longer time, and ultimately an hour a day, may be devoted to massage. A hot sponge bath may be given in the early morning and the clothing of the patient be changed.

At the end of ten days an egg or a chop should be eaten at noon, in addition to the usual allowance of milk. Weir Mitchell often prescribes earlier than this meat-juice once or twice in the day. In another day or two, bread and butter are given, and an egg or some meat at breakfast as well as at dinner. Some simple vegetable and stewed fruit may soon be added to the diet. By degrees the patient is thus gotten upon a diet of three simple but generous meals daily, besides three of four pints of milk. The latter is administered partly with the meals and partly between them.

While the patient is upon milk only, she is not permitted even to sit up in bed. But when three meals a day are taken, she may sit up while eating. At first solid foods are cut fine, and at all times they must be eaten slowly and well masticated before swallowing. Weir Mitchell recommends the generous use of butter, and in those cases in which flesh is not rapidly gained, the administration of cod-liver oil. If swallowing the oil lessens appetite or creates nausea an emulsion may be injected by the rectum.

When patients first are permitted to sit up, it is for a short time only. By degrees they are allowed to be up more hours in the day, but for some time after their morning bath, and again after massage, they ought to rest.

During treatment the stools should be watched. If food is voided undigested, the amount should be lessened. A urine loaded with urates also indicates overfeeding.

When, at the end of eight or ten weeks, the patient is permitted to return home, her gain in flesh, in color, in vigor, and mental poise is so great that convalescence appears fully established, yet recovery is not complete. The diet should still continue to be generous and simple; excitement should be avoided, and outdoor exercise encouraged.

Patients requiring this treatment easily become addicted to the use of alcoholic beverages, wherefore it is often desirable to forbid them entirely. When this is not necessary, some physicians permit their moderate employment. As they are not necessary, it is usually safer not to employ them at all.

Electricity - the faradaic current - is occasionally used to supplement massage. Also iron and strychnin, as well as tonic laxatives, like aloes and cascara sagrada, are often needed.

The following synopsis of the management of an individual case of Weir Mitchell's is appended to illustrate the practical application of the rest cure:

Mrs. C, kept in bed, fed by an attendant, rose only to relieve bladder and rectum.

First day: One quart of milk in divided doses every three hours.

Second day: Cup of coffee on awakening. Two quarts of milk in divided doses every two hours. Aloetic pill at night.

Third to sixth day: Same diet.

Seventh, eighth, and ninth days: Same diet, with a pint of raw soup1 in three portions.

Tenth day: 7 a. m., coffee. 7.30 a. m., half a pint of milk. 10 a. m., 12 noon, 2, 4, 6, 8, and 10 p. m., ditto. Soup at 11 a. m., 5, and 9 p. m.

1 This is made by chopping up one pound of raw beef and placing it in a bottle with a pint of water and five drops of strong hydrochloric acid. The mixture stands in ice all night; in the morning the bottle is put into a pan of water at 110° F., and kept two hours at about that temperature. The mixture is then thrown into a stout cloth and strained until the mass that remains is nearly dry. If the raw taste proves very objectionable, the beef to be used is first quickly broiled on one side and then the process is completed in the manner previously described.

Fourteenth day: Eggs, and bread and butter added.

Sixteenth day: Dinner added and iron.

Nineteenth day: The entire diet was as follows: 7 a. m., coffee. 8 a. m., iron and malt extract; breakfast, consisting of a chop, bread and butter, a tumbler and a half of milk. 11 a. m., soup. 2 p. m., iron and malt; dinner of anything liked, with six ounces of Burgundy or dry champagne, and at end one or two tumblers of milk. 4 p. m., soup. 7 p. m., malt, iron, bread and butter, usually some fruit, and two glasses of milk. 9 P.M., soup. 10 p. m., aloetic pill.

At 12 noon, massage for an hour. At 4.30 p. m., electricity applied for an hour.

Sixth week: Soup and wine were dropped, iron lessened one-half; massage and electricity only on alternate days; 1/30 of a grain of strychnin sulphate thrice a day at meals given (continued for several months).

Ninth week: Milk reduced to a quart. All mechanical treatment ceased.

Result: Gain in flesh about face in second week. Weight rose in two months from 96 to 136 pounds; gain in color equally marked. On thirtieth day patient had normal catamenial flow, after five years of failure to menstruate. Ninth week, drove out. Cure complete and permanent.