62 OVER-NtJTRITION AND tlNDER-NUTfi-ITION 



upon. It is quite uncertain whether an accumulation of muscle will take 

 place; with an equal amount of surplus nourishment the gain in muscle 

 varies from case to case. It is sometimes lacking, in' other cases it occurs to 

 a greater or less extent. But it may be prophesied with mathematical cer- 

 tainty that in over-nutrition fat will accumulate. How much is dependent 

 upon the amount of food, and how much upon the amount of work performed 

 by the body? A disproportion between the supply of food and the assimila- 

 tion of food, to which the accumulation of fat (and ultimately obesity) 

 owes its origin, can be brought about: 



1. By an increase of the food above an average normal consumption; 



2. By diminution of exertion (muscle laziness) with an average normal 

 amount of food; 



3. By a combination of superfluous food and diminished exertion. 



We frequently meet with cases of over-nutrition, but we are not so often 

 called upon professionally to combat this condition as we are to treat under- 

 nutrition. Occasionally, however, we are called to deal either with obesity or 

 with persons who, by continuing their present mode of life, are in danger of be- 

 coming too fat. Every corpulent person has behind him a period of over-nutri- 

 tion ; not, perhaps, because he has eaten more than others who have not become 

 fat, but he has eaten more than his individual constitution and bodily func- 

 tions enabled him to utilize. It is immaterial whether this superfluous inges- 

 tion of food has arisen in consequence of a preference for albumin, for fat, 

 for carbohydrates, or for alcohol ; we meet with obesity among decided meat- 

 and-fat eaters as well as among those who prefer starchy foods, sweets, and 

 beer. We observe it among those who perform hard manual labor, but who 

 more than compensate for their great metabolism and output of energy by a 

 profuse intake of food ; we observe it also in those who, although they eat little, 

 consume an amount of food out of proportion to their slight physical activity, 

 slight metabolism and slight output of strength. To elaborate this in indi- 

 vidual instances would be to consider the etiology and pathogenesis of obesity, 

 which is not the purpose of this article (the reader is referred to my mono- 

 graph on obesity in Nothnagel's Handbuch der speciellen Pathologie und 

 Therapie). 



Whether in the development of corpulence there is an increase of the mus- 

 cles depends, -as we observe daily, upon external conditions. The rule holds 

 good that only those obese persons who utilize and, in spite of their corpu- 

 lence, exercise their muscles have strong and firm muscles. In such people 

 we see the picture of the so-called " plethoric obesity." Those who live much 

 indoors have flabby and weak muscles, often so weak that serious consequences 

 may be the result. Distressing yet convincing proofs are thus furnished to 

 show how loose is the connection between over-nutrition and increase of muscle. 



5. INDICATIONS FOR HYPERNUTRITION AND HYPONUTRITION 



Having explained the changes of metabolism which occur in the organ- 

 ism in under-nutrition and over-nutrition, we must briefly discuss the indi- 

 cations for forced feeding and for antifat cures. 



