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Page 6
Facts of this nature suggest that the putting on of fat must be due to
very generalized conditions, and be less under the control of local
causes than is the nutrition of muscles, for, while it is true that in
wasting from nerve-lesions the muscular and fatty tissues alike lessen,
it is possible to cause by exercise rapid increase in the bulk of muscle
in a limb or a part of a limb, but not in any way to cause direct and
limited local increment of fat.
Looking back over the whole subject, it will be well for the physician
to remember that increase of fat, to be a wholesome condition, should be
accompanied by gain in quantity and quality of blood, and that while
increase of flesh after illness is desirable, and a good test of
successful recovery, it should always go along with improvement in
color. Obesity with thin blood is one of the most unmanageable
conditions I know of.
The exact relations of fatty tissue to the states of health are not as
yet well understood; but, since on great exertion or prolonged mental or
moral strain or in low fevers we lose fat rapidly, it may be taken for
granted that each individual should possess a certain surplus of this
readily-lost material. It is the one portion of our body which comes and
goes in large amount. Even thin people have it in some quantity always
ready, and, despite the fluctuations, every one has a standard share,
which varies at different times of life. The mechanism which limits the
storing away of an excess is almost unknown, and we are only aware that
some foods and lack of exertion favor growth in fat, while action and
lessened diet diminish it; but also we know that while any one can be
made to lose weight, there are some persons who cannot be made to gain a
pound by any possible device, so that in this, as in other things, to
spend is easier than to get; although it is clear that the very thin
must certainly live, so to speak, from hand to mouth, and have little
for emergencies. Whether fat people possess greater power of resistance
as against the fatal wasting of certain maladies or not, does not seem
to be known, and I fancy that the popular medical belief is rather
opposed to a belief in the vital endurance of those who are unusually
fat.
That I am not pushing too far this idea of the indicative value of gain
of weight may be further seen in persons who suffer from some incurable
chronic malady, but who are in other respects well. The relief from
their disease, even if temporary, is apt to be signalled by abrupt gain
in weight. A remarkable illustration is to be found in those who suffer
periodically from severe pain. Cessation of these attacks for a time is
sure to result in the putting on of flesh. The case of Captain
Catlin[10] is a good example. Owing to an accident of war, he lost a
leg, and ever since has had severe neuralgic pain referred to the lost
leg. These attacks depend almost altogether on storms. In years of
fewest storms they are least numerous, and the bodily weight, which is
never insufficient, rises. With their increase it lowers to a certain
amount, beneath which it does not fall. His weight is, therefore,
indirectly dependent upon the number of storms to the influence of which
he is exposed.
At present, however, we have to do most largely with the means of
attaining that moderate share of stored-away fat which seems to indicate
a state of nutritive prosperity and to be essential to those physical
needs, such as protection and padding, which fat subserves, no less than
to its �sthetic value, as rounding the curves of the human form.
The study of the amount of the different forms of diet which is needed
by people at rest, and by those who are active, is valuable only to
enable us to construct dietaries with care for masses of men and where
economy is an object. In dealing with cases such as I shall describe, it
is needful usually to give and to have digested a surplus of food, so
that we are more concerned now to know the forms of food which thin or
fatten, and the means which aid us to digest temporarily an excess.
As to quantity, it suffices to say that while by lessening food we may
easily and surely make people lose weight, we cannot be sure to fatten
by merely increasing the amount of food given; something more is wanted
in the way of digestives or tonics to enable the patient to prepare and
appropriate what is given, and but too often we fail miserably in all
our means of giving capacity to assimilate food. As I have said before,
and wish to repeat, to gain in fat is, in the feeble, nearly always to
gain in blood; and I hope to point out in these pages some of the means
by which these ends can be attained.
_Note_.--The statements made on page 21 and the following
paragraphs about obesity in England and with us are no longer
exact, but have been allowed to stand in the text as recording
facts true at the time of writing them, in 1877. At the present a
medical observer familiar with both countries must note several
decided changes: more fat people, more people even enormously
stout, are seen with us than formerly, and fewer of the
"inordinately fat middle-aged people" in England than used to be
encountered. With us the over-fat are chiefly to be found among the
women of the well-to-do classes of the cities, and from thirty
years old onward. They persecute the medical men to reduce their
weight, and the vast number of advertisements of quack and
proprietary remedies against obesity indicate how wide-spread the
tendency must be.
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