It says that there shall be an element called General-List
and that it shall contain elements called Item:
there must be at least one Item (that's the plus sign)
but there may be more than one.
It also says that the Item element
may contain only parsed character data
(PCDATA, ie text: no further markup).
Because there is no other element which contains General-List,
that element is assumed to be the ‘root’ element,
which encloses everything else in the document.
You can now use it to create an XML file: give your editor the declarations:
<?xml version="1.0"?> <!DOCTYPE General-List SYSTEM
"general.dtd">
(assuming you put the DTD in that file).
Now your editor will let you create files according to the pattern: