Fat and Blood | Page 8

not unimportant aids towards health, but in such cases require to be
handled with an amount of caution which is less requisite in more
chronic conditions of disordered health.
In other and fatal or graver maladies, such as, for example, advanced
pulmonary phthisis, however proper it may be to fatten, it is almost an
impossible task, and, as Pollock remarks, the lung-trouble may be
advancing even while the patient is gaining in weight. Nevertheless, the
earlier stages of pulmonary tuberculosis are suitable cases, and with
sufficient attention to purity and frequent change of air in their rooms
tubercular sufferers may be brought by this means to a point of
improvement where open-air and altitude cures will have their best
effects.

There remains a class of cases desirable to fatten and redden,--cases
which are often, or usually, chronic in character, and present among
them some of the most difficult problems which perplex the physician.
If I pause to dwell upon these, it is because they exemplify forms of
disease in which my method of treatment has had the largest success; it
is because some of them are simply living records of the failure of
every other rational plan and of many irrational ones; it is because
many of them find no place in the text-book, however sadly familiar
they are to the physician.
The group I would speak of contains that large number of people who
are kept meagre and often also anæmic by constant dyspepsia, in its
varied forms, or by those defects in assimilative processes which, while
more obscure, are as fertile parents of similar mischiefs. Let us add the
long-continued malarial poisonings, and we have a group of varied
origin which is a moderate percentage of cases in which loss of weight
and loss of color are noticeable, and in which the usual therapeutic
methods do sometimes utterly fail.
For many of these, fresh air, exercise, change of scene, tonics, and
stimulants are alike valueless; and for them the combined employment
of the tonic influences I shall describe, when used with absolute rest,
massage, and electricity, is often of inestimable service.
A portion of the class last referred to is one I have hinted at as the
despair of the physician. It includes that large group of women,
especially, said to have nervous exhaustion, or who are defined as
having spinal irritation, if that be the prominent symptom. To it I must
add cases in which, besides the wasting and anæmia, emotional
manifestations predominate, and which are then called hysterical,
whether or not they exhibit ovarian or uterine disorders.
Nothing is more common in practice than to see a young woman who
falls below the health-standard, loses color and plumpness, is tired all
the time, by and by has a tender spine, and soon or late enacts the
whole varied drama of hysteria. As one or other set of symptoms is
prominent she gets the appropriate label, and sometimes she continues
to exhibit only the single phase of nervous exhaustion or of spinal

irritation. Far more often she runs the gauntlet of nerve-doctors,
gynæcologists, plaster jackets, braces, water-treatment, and all the
fantastic variety of other cures.
It will be worth while to linger here a little and more sharply delineate
the classes of cases I have just named.
I see every week--almost every day--women who when asked what is
the matter reply, "Oh, I have nervous exhaustion." When further
questioned, they answer that everything tires them. Now, it is vain to
speak of all of these cases as hysterical, or as merely mimetic. It is
quite sure that in the graver examples exercise quickens the pulse
curiously, the tire shows in the face, or sometimes diarrhoea or nausea
follows exertion, and though while under excitement or in the presence
of some dominant motive they can do a good deal, the exhaustion
which ensues is out of proportion to the exercise used.
I have rarely seen such a case which was not more or less lacking in
color and which had not lost flesh; the exceptions being those
troublesome instances of fat anæmic people which I shall by and by
speak of more fully.
Perhaps a sketch of one of these cases will be better than any list of
symptoms. A woman, most often between twenty and thirty years of
age, undergoes a season of trial or encounters some prolonged strain.
She may have undertaken the hard task of nursing a relative, and have
gone through this severe duty with the addition of emotional
excitement, swayed by hopes and fears, and forgetful of self and of
what every one needs in the way of air and food and change when
attempting this most trying task. In another set of cases an illness is the
cause, and she never rallies entirely, or