Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Franklin Inn Club
Hidden in a back alley near the theaters, this little club is the center of the City's literary circle. It enjoys outstanding food in surroundings which suggest Samuel Johnson's club in London.

Another Toast to S. Weir Mitchell

Proposed to the Annual Dinner of the Franklin Inn Club, 16 January 2009:

p>In the century after Benjamin Franklin, one of the most diversely creative Americans was S. Weir Mitchell. Like Franklin, he was an empirical scientist. But whereas Franklin went in the direction of homely philosophy, diplomacy, and urban institutions, Mitchell shot off into practical and theoretical medicine and was the first president of the American Neurological Association. He wrote several historical novels, some juvenile literature, and 440 pages of collected poems; as well as the penetrating case studies, essays, and books he contributed to medicine.

The year after Mitchell helped found The Franklin Inn Club, 1902, a painting of him was commissioned, by John Singer Sargent. The world’s leading social portraitist was 47; his subject was 74. Sargent fretted over the beard, and muttered, “I mustn’t make him look like a goat.” Mitchell’s thin, silvery beard nonetheless looks like an afterthought, brushed over his clothing. Mitchell’s left-hand rests awkwardly on a book standing vertically, index finger inserted, holding a place. His light blue eyes look watery and accusing as if from eyestrain combined with irritability at keeping still for this arrogant young Englishman. When the painter finished he exclaimed, “At least it is a Sargent.” To which the sitter replied, “Yes, and it is of S. Weir Mitchell.”

Mitchell’s own fame dated from experience as a surgeon in the Civil War and a book on gunshot wounds, a classic still used by the French in World War I. If he was active today, editorial writers would be quoting Mitchell on whether or not post-traumatic stress disorder should qualify a warrior for the Purple Heart. He also generated monographs on rattlesnake poison, and on relations among nurses, physicians, and patients. Most famously, his “Rest Cure” for depressed patients was adopted in Europe, and some of its features remain in practice today in Japan and China.

We may see Weir Mitchell, then, as one of the great medical figures between the first surgical anesthesia and the eminence of Sigmund Freud. But where exactly fit him? Critics of the Rest Cure might say that he came to embody the title of a short story he wrote during the Civil War 'Autobiography of a Quack. It is easy to concede that he may have been a strange duck; but I should also insist that he was a pioneer in experimental physiology, studying carefully how things happen in the human body and mind.

That said, I wonder about the title of his classic book on the treatment of hysteria and neurasthenia, which went through eight editions before his death in 1914. Its title is Fat and Blood. Something seems wrong there. He believed that neuralgic conditions of all kinds were treatable by managing ratios between blood and fat. His theory figured centrally in the Rest Cure, which required four to eight weeks of seclusion, away from family and intellectual work, in the care of a nurse who bathed, dressed, and massaged the patient, while a doctor occasionally prescribed electricity and dietetics, and studied weight gain, which would be evidence of improvement. (This, after all, was the age of Lillian Russell, no slender beauty; and of William Howard Taft, who at peak weighed 335 pounds.) We may be allowed skepticism regarding features of Mitchell’s treatment: about seclusion, because we are ultra-sociable; about rest and no-use-of-hands, because our age is hyperactive; about massage, which we believe yields only a transient “feel-good” effect; about electricity, which we think useful only in careful shock doses; and about exotic pharmaceuticals such as the glycerin that Mitchell valued, which was specially extracted from bull’s testicles.

If we read the short story by Charlotte Perkins Gilman, The Yellow Wallpaper, we may get an even darker view of the Rest Cure. This utopian feminist and prolific writer suffered postpartum depression after her first daughter was born, and for it, she undertook Mitchell’s treatment. In her story, a secluded woman obsesses with the sickly color and creepy patterns of the wallpaper and imagines them hiding a woman who wants to get out. She goes mad and rips the paper off the wall to let the tortured prisoner free. In reality, Gilman ignored Mitchell’s advice against resuming intellectual activity, and flung herself back into it for the rewards of “joy and growth and service.”

Perhaps Gilman’s reputation as a feminist contributes to Mitchell’s as a misogynist. But that charge I believe is wrong. He had many woman friends, and many female patients adored him '" all without scandal. He may have erred in treatment, but his very focus on conditions suffered by educated women was novel in his time. Women were subject to hysteria (which in male doctor language appeared to mean restless, bitchy women), and neurasthenia (which implied more docile, pleasing women). Both kinds might endure headaches, fatigue, anxiety, loss of appetite and motivation, and even suicidal thoughts. [Nowadays, simply “depression.”] But then neurasthenia was taken as ordinary for women, meaning affluent urban women, and certainly not freed slave women. Men, of course, were also subject to such vapors, which they should treat with a stiff upper lip, or to ulcers and heart attacks, which Mitchell also wished to cure and prevent. These stress-produced conditions, as early as 1869, were traced to competitive capitalism. Americans were thought especially prone to neurasthenia, and when William James suffered it, he called it “Americanitis.”

Weir Mitchell’s advance was to approach the condition experimentally and pragmatically. At that time, mental illness was associated with the madhouse. Instead, he considered it as common and treatable. His chief distorting error, surely, was an excess of empiricism, in trying to base every distress and its cure in bodily function. He nonetheless appreciated psychodynamics, and many anecdotes attest to his high appreciation for women and his sensitivity to them. His net contribution was major: Mitchell domesticated mental illness, so to speak, and laid some of the bases for modern psychosomatic medicine.

For an attentive physician and engaging conversationalist, I wish we could still find Weir Mitchell, a short distance west of our Inn at 1524 Walnut Street. To his office at home came numerous patients, who were admitted by a male servant in a red vest and swallowtail coat. It was an easy walk for Weir, of course, to come here to Camac Street, for the kind of conversations with J. William White and others that he cherished: unpredictable, wide-ranging, based on frontiers of knowledge; open to controversy, and hospitable to disagreement, far beyond the norms of Philadelphia society.

Although we cannot host our founder in fact, let us thank him warmly for starting up the Franklin Inn, and together toast his spirit: to S. Weir Mitchell!

Theodore Friend


1. published: Ernest Earnest, S. Weir Mitchell, Novelist and Physician (Philadelphia, University of Pennsylvania Press, 1950)

2. web/Wikipedia/Google/ Google Images:

Charlotte Perkins Gilman

S. Weir Mitchell


Rest Cure

John Singer Sargent

Elaine Showalter (selections from The Female Malady)

Originally published: Thursday, February 12, 2009; most-recently modified: Monday, May 13, 2019