448 THE METABOLISM OF THE TISSUES. 



of fat and 170 grams of carbohydrates. It is, however, not advisable to restrict 

 a corpulent person excessively as to fats and carbohydrates alone, as is customary 

 in the so-called cure of Banting. Such a violent modification of the normal diet 

 is often attended with profound derangement of the entire metabolism. Many 

 persons have suffered greatly in health as a result of this procedure. Every long- 

 continued limitation of diet in one direction is deleterious and will accordingly 

 result in emaciation, but not without danger, for it has a disturbing influence upon 

 the entire metabolism and thus in a given sense is pathological. (2) It is advisable 

 during the principal meals to avoid as much as possible the use of fluids of all 

 kind (until about three-quarters of an hour later) , because by this means the 

 absorption and the digestive activity in the intestine are rendered less effective. 

 (3) Muscular activity should be increased by vigorous work, and also mental 

 activity should be encouraged. (4) Heat-dissipation should be favored by cold 

 baths of long duration, followed by vigorous friction of the skin to the point of 

 bright redness. At the same time the clothing should be light. The patient 

 should sleep in a cool room and for not too long a time. In this manner the 

 increased ingestion of tea and coffee also is useful, actively stimulating the cuta- 

 neous circulation and thereby the dissipation of heat. (5) Mild laxatives, such as 

 acid fruits, cider, alkaline carbonates (Marienbad, Carlsbad, Vichy, Neuenahr, Ems, 

 etc.), have a favorable influence in the correction of obesity by increasing the 

 evacuations from the intestines and diminishing absorption. (6) If, in the pres- 

 ence of marked deposition of fat, there is already danger of enfeeblement of the 

 action of the heart an attempt should be made, with caution, by means of in- 

 creased muscular activity (mountain-climbing and the like), to stimulate the 

 heart and to strengthen its musculature. By this means the circulation is improved 

 and metabolism becomes more active, so that recovery may even yet be brought 

 about with the aid of a sensible diet. 



Entirely different from the process of fattening, which consists in the deposi- 

 tion of large droplets of fat in the fat-cells of the panniculus and about the viscera, 

 as well as in the bone-marrow (but never in the subcutaneous connective tissue 

 of the eyelids, the penis, the red margin of the lips, the ears, the nose), is the con- 

 dition of fatty atrophy or fatty degeneration, which occurs in the form of fatty 

 granules in the albuminous tissues, for example, in muscle-fibers (of the heart), 

 glandular cells (liver, kidneys), cartilage-cells, lymph-corpuscles and pus-corpus- 

 cles, as well as in divided nerves. If this process increases in the tissues to such 

 a degree that the albumin is as a result made to disappear without being again 

 restored, the fatty atrophy or degeneration is marked. It is observed after severe 

 fevers, marked (artificial) heating of the tissues, diminished absorption of oxygen 

 into the body (as has been observed especially after phosphorus-poisoning), also 

 in drunkards, after certain forms of intoxication (arsenic), and in connection with 

 disorders of circulation and innervation. Finally, some organs exhibit fatty de- 

 generation in connection with special diseases. In rare cases in the new-born the 

 entire body may rapidly undergo fatty atrophy. 



THE METABOLISM OF THE TISSUES. 



All tissues require for their normal existence and for their functional 

 activity the process of metabolism. The chief medium for this is the 

 blood-current, which, acting as the principal traffic-carrier in the metab- 

 olic process, conveys the material for the restoration of the tissues and re- 

 moves the products of their vital activity. Those tissues that, like the 

 cornea and cartilage, possess no vessels in their structure, must receive the 

 nutritive plasmatic fluid from the adjacent capillaries through their 

 cellular elements, which thus act as channels for the conveyance of the 

 fluid. Therefore, interference with the normal circulation in the tissues, 

 as, for example, through constriction or calcification of the walls of the 

 vessels and the like, is attended with derangement of nutrition; com- 

 plete occlusion, as, for example, by thrombosis, total compression, or 

 artificially by ligature of all the afferent vessels, is followed by certain 

 destruction of the tissues, which soon appears in the form of gangrene 

 (necrosis). 



