INCREASE OF FLESH AND INCREASE OF FAT 55 



other hand, there is a wide space for the conception of a "medium state of 

 nutrition." Although this conception permits no positive statement as to 

 the amount of superfluous fat, no definite body-weight, no distinct relation 

 between weight and size, age and sex, that can be called normal, it must, 

 nevertheless, be maintained that, for each individual, there is a definite stand- 

 ard for the condition of nutrition, particularly with regard to the amount of 

 fat. To recognize this optimum is the duty of the physician, and presup- 

 poses much thought and experience. Good judgment will take into considera- 

 tion the state of health, the competency of all the organs, and the entire mode 

 of life. A few examples will illustrate this. Experience teaches us that 

 persons who are predisposed to tuberculosis are endangered by leanness, and 

 that a certain degree of corpulence protects them. Neurasthenics, as a rule, 

 feel better if they have a large amount of adipose tissue. For patients suffer- 

 ing from disease of the heart, Bright's disease, and emphysema the slightest 

 amount of superfluous fat is an evil, and in diseases that affect the organs 

 of motion, obesity is, at least, the cause of great annoyance. Persons who 

 perform hard labor continue in better health and are more capable of working 

 if their adipose tissue is not too greatly developed. Those who have passed 

 the prime of life, and are no longer compelled to work hard, bear a certain 

 development of corpulency better than those Just beginning the struggle for 

 existence. These points will be amplified in the description of the indica- 

 tions for over-nutrition and under-nutrition. 



It follows from what has been said that in all treatment by which we 

 attempt to influence nutrition, we must first of all try to maintain and 

 improve the muscles; in certain cases, however, we attempt nutritive cures 

 in which increase or diminution of adipose tissue represents the sole aim of 

 the treatment. Even in these, however, the state of the muscles must not be 

 lost sight of. The importance of this must be emphasized, for very frequently 

 it is forgotten. We sometimes see patients with weak muscles who in the 

 process of " strengthening " are fattened by various means, and when the 

 cure is done we find obese subjects with feeble muscles. Again we see corpu- 

 lent persons subjected to such irrational antifat cures that not only the fat 

 but also the muscles and blood are depleted, and the activity of their func- 

 tions permanently injured. 



Our theme will be the question: How far can and should the general 

 condition of nutrition, i. e., of muscle and fat, be influenced by dietetic treat- 

 ment? 



2. INCREASE OF FLESH AND INCREASE OF FAT 



To accomplish the most important point, the accumulation of muscle, 

 dietetic treatment has, unfortunately, but limited powers. Theoretically it 

 appears to be most difficult to maintain the musculature of the body in anti- 

 fat cures. The animal experiments of physiologists have invariably shown 

 that with under-nourishment fat disappears from the body, but that albumin 

 also decreases. To this loss of body albumin, that is to say, waste of muscle, 

 we owe the serious consequences which frequently surprise those who carry 

 out a too rapid antifat cure. Discussions regarding the admixture and 



