58 OVER-NUTRITION AND UNDER-NUTRITION 



Of course, under circumstances otherwise favorable for the accumulation 

 of albumin, muscular development takes place more certainly and more rap- 

 idly with very profuse nourishment than with scant foOd. Usually, however, 

 in adults otherwise healthy — provided we consider long periods of time and 

 not brief intervals — muscle-increase is independent of an excess of food. 

 Muscle growth is dependent on food supply only because the body is better 

 supplied by over-nutrition with reserve products (glycogen, fat, reserve albu- 

 min), and because better food and the somatic and psychical stimulation 

 resulting from it produce greater capacity for work. To this greater capacity 

 of the muscles and secreting glands for work and the stimulus for blood for- 

 mation which arises thereby, the body owes its power of accumulating proto- 

 plasm as well as fat, and — what is more important — of permanently retain- 

 ing it. 



From this point of view, it appears that under special conditions (after 

 wasting disease or after prolonged periods of hunger and under-nutrition) we 

 may hope by over-alimentation to promote the formation of new protoplasm, 

 and particularly of muscular substance. The natural regenerative endeavor 

 of the organism will aid us. If, however, we are treating persons who, 

 although weak, are sufficiently well nourished, the chances for increased mus- 

 cular development are much more uncertain. 



In such debilitated individuals, especially in convalescents, the accumula- 

 tion of flesh will be greatly favored, if from the onset, or as soon as the 

 strength at all permits it, forced feeding is combined with muscular exercise. 

 This, however, contradicts a widely prevalent custom; for, in the original 

 methods of Playfair-Mitchell, most patients who were to undergo forced 

 feeding were advised either to go to bed or to keep as quiet as possible. In 

 certain cases, for example, in very irritable nervous persons, this may be fully 

 Justified. Generally, however, it appears to me after years of experience that 

 early and sufficient activity of the muscles is much more beneficial when we 

 desire to nourish our patient. The increase in weight is not less than in rest 

 cures, and it is gratifying to note that the patients gain in muscular strength 

 and activity at the same time that they increase in weight and size. There 

 is very little danger that, in consequence of muscular exercise, much of the 

 fat which has been acquired with difficulty may be again lost, since the in- 

 crease of appetite induced by muscular exercise easily makes good the material 

 used up. 



In view of what has been said it is obvious that in forced feeding, as well 

 as in carefully and wisely conducted antifat cures (for obesity), the increase 

 and strengthening of the muscles is almost independent of the loss or accumu- 

 lation of fat. Insufficient nourishment in obesity favors the loss of muscle; 

 superfluous nourishment both in normal nutrition and when it is below par 

 favors the accumulation of muscle. But muscle-loss and muscle-increase are 

 not in immediate dependence upon, or in exact proportion to, the quantity of 

 food. An individual factor always intervenes; an elective property of the 

 organism rather than the bulk of food produces muscle-accumulation. 



The conditions are quite different in losses and accumulations of fat. 

 Here the law may be definitely stated. When the supply of nourishment is 



