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Page 3
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 in
condition to keep up the supply of fat which we not only require for
constant use but probably need to change continually. The steady or
rapid lessening of the deposits of hydro-carbons stored away in the
areol� of the tissues is of importance, as indicating their excessive
use or a failure of supply; and when either condition is to be suspected
it becomes our duty to learn the reasons for this striking symptom. Loss
of flesh has also a collateral value of great import, because it is
almost an invariable rule that rapid thinning is accompanied soon or
late with more or less an�mia, and it is uncommon to see a person
steadily gaining fat after any pathological reduction of weight without
a corresponding gain in amount and quality of blood. We too rarely
reflect that the blood thins with the decrease of the tissues and
enriches as they increase.
Before entering into this question further, I shall ask attention to
some points connected with the normal fat of the human body; and, taking
for granted, here and elsewhere, that my readers are well enough aware
of the physiological value and uses of the adipose tissues, I shall
continue to look at the matter chiefly from a clinical point of view.
When in any individual the weight varies rapidly or slowly, it is nearly
always due, for the most part, to a change in the amount of adipose
tissue stored away in the meshes of the areolar tissue. Almost any grave
change for the worse in health is at once betrayed in most people by a
diminution of fat, and this is readily seen in the altered forms of the
face, which, because it is the always visible and in outline the most
irregular part of the body, shows first and most plainly the loss or
gain of tissue. Fatty matter is therefore that constituent of the body
which goes and comes most easily. Why there is in nearly every one a
normal limit to its accumulation we cannot say, nor yet why this limit
should vary as life goes on. Even in health the weight of men, and still
more of women, is by no means constant, but, as a rule, when we are
holding our own with that share of stored-up fat which belongs to the
individual we are usually in a condition of nutritive prosperity, and
when after any strain or trial which has lessened weight we are slowly
repairing mischief and laying by fat we are equally in a state of
health. The loss of fat which is not due to change of diet or to
exercise, especially its rapid or steady loss, nearly always goes along
with conditions which impoverish the blood, and, on the other hand, the
gain of fat up to a certain point seems to go hand in hand with a rise
in all other essentials of health, and notably with an improvement in
the color and amount of the red corpuscles.
The quantity of fat which is healthy for the individual varies with the
sex, the climate, the habits, the season, the time of life, the race,
and the breed. Quetelet[3] has shown that before puberty the weight of
the male is for equal ages above that of the female, but that towards
puberty the proportional weight of the female, due chiefly to gain in
fat, increases, so that at twelve the two sexes are alike in this
respect. During the child-bearing time there is an absolute lessening on
the part of the female, but after this time the weight of the woman
increases, and the maximum is attained at about the age of fifty.
Dr. Henry I. Bowditch[4] reaches somewhat similar conclusions, and shows
from much more numerous measurements of Boston children that growing
boys are heavier in proportion to their height than girls until they
reach fifty-eight inches, which is attained about the fourteenth year.
Then the girl passes the boy in weight, which Dr. Bowditch thinks is due
to the accumulation of adipose tissue at puberty. After two or three
years more the male again acquires and retains superiority in weight and
height.
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