The following quotation from Dr. William Playfair’s essay[1] says all that I would care to add: 

“The claims of Dr. Weir Mitchell to originality in the introduction of this system of treatment, which I have recently heard contested in more than one quarter, it is not my province to defend.  I feel bound, however, to say that, having carefully studied what has been written on the subject, I can nowhere find anything in the least approaching to the regular, systematic, and thorough attack on the disease here discussed.

“Certain parts of the treatment have been separately advised, and more or less successfully practised, as, for example, massage and electricity, without isolation; or isolation and judicious moral management alone.  It is, in fact, the old story with regard to all new things:  there is no discovery, from the steam-engine down to chloroform, which cannot be shown to have been partially foreseen, and yet the claims of Watt and Simpson to originality remain practically uncontested.  And so, if I may be permitted to compare small things with great, will it be with this.  The whole matter was admirably summed up by Dr. Ross, of Manchester, in his remarks in the discussion I introduced at the meeting of the British Medical Association at Worcester, which I conceive to express the precise state of the case:  ’Although Dr. Mitchell’s treatment was not new in the sense that its separate recommendations were made for the first time, it was new in the sense that these recommendations were for the first time combined so as to form a complete scheme of treatment.’”

As regards the acceptance of this method of treatment I have to-day no complaint to make.  It runs, indeed, the risk of being employed in cases which do not need it and by persons who are not competent, and of being thus in a measure brought into disrepute.  As concerns one of its essentials—­massage—­this is especially to be feared.  It is a remedy with capacity to hurt as well as to help, and should never be used without the advice of a physician, nor persistently kept up without medical observation of its temporary and more permanent effects.

CHAPTER II.

Gain or loss of weight clinically considered.

The gentlemen who have done me the honor to follow my clinical service at the State Infirmary for Diseases of the Nervous System[2] are well aware how much care is there given to learn whether or not the patient is losing or has lost flesh, is by habit thin or fat.  This question is one of the utmost moment in every point of view, and deserves a larger share of attention than it receives.  In this hospital it is the custom to weigh our cases when they enter and at intervals.  The mere loss of fat is probably of small moment in itself when the amount of restorative food is sufficient for every-day expenditure, and when the organs are