16 APPLIED PHYSIOLOGY 



an excess of income over expenditure of energy, that a 

 patient will put on fat. Experience at the bedside seems 

 to show that there are persons whom it is almost im- 

 possible to fatten. What happens to any excess of food 

 supplied in such circumstances it is difficult to say, but 

 in many cases, at least, it appears to fail of elaboration in 

 the liver, and to induce a ' bilious attack,' by which in 

 some way it is got rid of. We shall return to the dis- 

 cussion of this subject, however, again. 



The three chief depots in which the surplus energy of 

 the body is stored in the form of fat are, in order of size 

 and importance, as follows : (i.) subcutaneous tissue ; 

 (ii.) abdominal cavity ; (iii.) intermuscular connective 

 tissue. When a man fattens, the subcutaneous and 

 intermuscular depots fill up first, the abdominal cavity 

 more slowly. Conversely, when energy is required by 

 the body to meet a chronic deficit in the intake, the 

 abdominal fat is drawn upon first,* then the fat below 

 the skin, and after that the intermuscular fat, whilst fat 

 in the organs is only made use of in extreme emergencies. 



A deficiency in the total amount of food consumed is 

 more serious than a deficiency of protein alone ; for in 

 the former case both protein and fat are lost by the 

 body, in the latter protein alone. Nor would it seem 

 that the loss of protein, when the total amount of energy 

 in the diet is defective, can be altogether prevented even 

 by consuming large quantities of protein food e.g. y meat. 



* The apparent persistence of a large abdomen, in spite of a 

 large reduction in the diet, which may seem to contradict this 

 statement, is really due to the large amount of subcutaneous fat in 

 the abdominal wall, that being a favourite site for its deposition. 



