Fat and Blood | Page 7

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 æsthetic 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.
Among women somewhat younger, as indeed among men, the
American observer whose recollection takes him back twenty-five
years must note a more hopeful change, a very decided average
increase of stature, not merely in height but in general development.
This change is to be seen throughout the whole country, and must be
taken first as a sign of improved conditions of food and manner of life,
and next, if not more largely, of the new interest and partnership of
girls in the wholesome activities of field and wood.


CHAPTER III.
ON THE SELECTION OF CASES FOR TREATMENT.
The remarks of the last chapter have, of course, wide and general
application in disease, and naturally lead up to what I have to say as to

the employment of the systematic treatment to describe which is my
chief desire. Its use, as a whole, is limited to certain groups of cases. In
some of the worst of them nothing else has succeeded hitherto, or at
least as frequently. In others the need for its application must depend
on convenience and the fact that all other and readier means have failed.
It is, of course, difficult to state now all the groups of diseases in which
it may be of value, for already physicians have begun to find it
serviceable in some to which I had not thought of applying it,[11] and
its sphere of usefulness is therefore likely to extend beyond the limits
originally set by me. It will be well here, however, to state the various
disorders in which it has seemed to me applicable. As regards some of
them, I shall try briefly to indicate why their peculiarities point it out as
needful.
There are, of course, numerous cases in which it becomes desirable to
fatten and to make blood. In many of them these are easy tasks, and in
some altogether hopeless. Persons who are recovering healthfully from
fevers, pneumonias, and other temporary maladies gather flesh and
make blood readily, and we need only to help them by the ordinary
tonics, careful feeding, and change of air in due season.
It may not, however, be out of place to say here that when the
convalescence from these maladies seems to be slower than is common,
and ordinary tonics inefficient, massage and the use of electricity are