Part 1 (1/2)
Fat and Blood.
by S. Weir Mitch.e.l.l.
CHAPTER I.
INTRODUCTORY.
For some years I have been using with success, in private and in hospital practice, certain methods of renewing the vitality of feeble people by a combination of entire rest and excessive feeding, made possible by pa.s.sive exercise obtained through the steady use of ma.s.sage and electricity.
The cases thus treated have been chiefly women of a cla.s.s well known to every physician,--nervous women, who, as a rule, are thin and lack blood. Most of them have been such as had pa.s.sed through many hands and been treated in turn for gastric, spinal, or uterine troubles, but who remained at the end as at the beginning, invalids, unable to attend to the duties of life, and sources alike of discomfort to themselves and anxiety to others.
In 1875 I published in ”Seguin's Series of American Clinical Lectures,”
Vol. I., No. iv., a brief sketch of this treatment, under the heading of ”Rest in the Treatment of Nervous Disease,” but the scope afforded me was too brief for the details on a knowledge of which depends success in the use of rest, I have been often since reminded of this by the many letters I have received asking for explanations of the minutiae of treatment; and this must be my apology for bringing into these pages a great many particulars which are no doubt well enough known to the more accomplished physician.
In the preface to the second edition I said that as yet there had been hardly time for a competent verdict on the methods I had described.
Since making this statement, many of our profession in America have published cases of the use of my treatment. It has also been thoroughly discussed by the medical section of the British Medical a.s.sociation, and warmly endorsed by William Playfair, of London, Ross of Manchester, Coghill, and others; while a translation of my book into French by Dr.
Oscar Jennings, with an introduction by Professor Ball, and a reproduction in German, with a preface by Professor von Leyden, have placed it satisfactorily before the profession in France and Germany.
As regards the question of originality I did not and do not now much concern myself. This alone I care to know, that by the method in question cases are cured which once were not; and as to the novelty of the matter it would be needless to say more, were it not that the charge of lack of that quality is sometimes taken as an imputation on a man's good faith.
But to sustain so grave an implication the author must have somewhere laid claim to originality and said in what respect he considered himself to have done a totally new thing. The following pa.s.sage from the first edition of this book explains what was my own position:
”I do not wish,” I wrote, ”to be thought of as putting forth anything very remarkable or original in my treatment by rest, systematic feeding, and pa.s.sive exercise. All of these have been used by physicians; but, as a rule, one or more are used without the others, and the plan which I have found so valuable, of combining these means, does not seem to be generally understood. As it involves some novelty, and as I do not find it described elsewhere, I shall, I think, be doing a service to my profession by relating my experience.”
The following quotation from Dr. William Playfair's essay[1] says all that I would care to add:
”The claims of Dr. Weir Mitch.e.l.l to originality in the introduction of this system of treatment, which I have recently heard contested in more than one quarter, it is not my province to defend. I feel bound, however, to say that, having carefully studied what has been written on the subject, I can nowhere find anything in the least approaching to the regular, systematic, and thorough attack on the disease here discussed.
”Certain parts of the treatment have been separately advised, and more or less successfully practised, as, for example, ma.s.sage and electricity, without isolation; or isolation and judicious moral management alone. It is, in fact, the old story with regard to all new things: there is no discovery, from the steam-engine down to chloroform, which cannot be shown to have been partially foreseen, and yet the claims of Watt and Simpson to originality remain practically uncontested. And so, if I may be permitted to compare small things with great, will it be with this. The whole matter was admirably summed up by Dr. Ross, of Manchester, in his remarks in the discussion I introduced at the meeting of the British Medical a.s.sociation at Worcester, which I conceive to express the precise state of the case: 'Although Dr. Mitch.e.l.l's treatment was not new in the sense that its separate recommendations were made for the first time, it was new in the sense that these recommendations were for the first time combined so as to form a complete scheme of treatment.'”
As regards the acceptance of this method of treatment I have to-day no complaint to make. It runs, indeed, the risk of being employed in cases which do not need it and by persons who are not competent, and of being thus in a measure brought into disrepute. As concerns one of its essentials--ma.s.sage--this is especially to be feared. It is a remedy with capacity to hurt as well as to help, and should never be used without the advice of a physician, nor persistently kept up without medical observation of its temporary and more permanent effects.
CHAPTER II.
GAIN OR LOSS OF WEIGHT CLINICALLY CONSIDERED.
The gentlemen who have done me the honor to follow my clinical service at the State Infirmary for Diseases of the Nervous System[2] are well aware how much care is there given to learn whether or not the patient is losing or has lost flesh, is by habit thin or fat. This question is one of the utmost moment in every point of view, and deserves a larger share of attention than it receives. In this hospital it is the custom to weigh our cases when they enter and at intervals. The mere loss of fat is probably of small moment in itself when the amount of restorative food is sufficient for every-day expenditure, and when the organs are in condition to keep up the supply of fat which we not only require for constant use but probably need to change continually. The steady or rapid lessening of the deposits of hydro-carbons stored away in the areolae of the tissues is of importance, as indicating their excessive use or a failure of supply; and when either condition is to be suspected it becomes our duty to learn the reasons for this striking symptom. Loss of flesh has also a collateral value of great import, because it is almost an invariable rule that rapid thinning is accompanied soon or late with more or less anaemia, and it is uncommon to see a person steadily gaining fat after any pathological reduction of weight without a corresponding gain in amount and quality of blood. We too rarely reflect that the blood thins with the decrease of the tissues and enriches as they increase.
Before entering into this question further, I shall ask attention to some points connected with the normal fat of the human body; and, taking for granted, here and elsewhere, that my readers are well enough aware of the physiological value and uses of the adipose tissues, I shall continue to look at the matter chiefly from a clinical point of view.
When in any individual the weight varies rapidly or slowly, it is nearly always due, for the most part, to a change in the amount of adipose tissue stored away in the meshes of the areolar tissue. Almost any grave change for the worse in health is at once betrayed in most people by a diminution of fat, and this is readily seen in the altered forms of the face, which, because it is the always visible and in outline the most irregular part of the body, shows first and most plainly the loss or gain of tissue. Fatty matter is therefore that const.i.tuent of the body which goes and comes most easily. Why there is in nearly every one a normal limit to its acc.u.mulation we cannot say, nor yet why this limit should vary as life goes on. Even in health the weight of men, and still more of women, is by no means constant, but, as a rule, when we are holding our own with that share of stored-up fat which belongs to the individual we are usually in a condition of nutritive prosperity, and when after any strain or trial which has lessened weight we are slowly repairing mischief and laying by fat we are equally in a state of health. The loss of fat which is not due to change of diet or to exercise, especially its rapid or steady loss, nearly always goes along with conditions which impoverish the blood, and, on the other hand, the gain of fat up to a certain point seems to go hand in hand with a rise in all other essentials of health, and notably with an improvement in the color and amount of the red corpuscles.
The quant.i.ty of fat which is healthy for the individual varies with the s.e.x, the climate, the habits, the season, the time of life, the race, and the breed. Quetelet[3] has shown that before p.u.b.erty the weight of the male is for equal ages above that of the female, but that towards p.u.b.erty the proportional weight of the female, due chiefly to gain in fat, increases, so that at twelve the two s.e.xes are alike in this respect. During the child-bearing time there is an absolute lessening on the part of the female, but after this time the weight of the woman increases, and the maximum is attained at about the age of fifty.
Dr. Henry I. Bowditch[4] reaches somewhat similar conclusions, and shows from much more numerous measurements of Boston children that growing boys are heavier in proportion to their height than girls until they reach fifty-eight inches, which is attained about the fourteenth year.
Then the girl pa.s.ses the boy in weight, which Dr. Bowditch thinks is due to the acc.u.mulation of adipose tissue at p.u.b.erty. After two or three years more the male again acquires and retains superiority in weight and height.
Yet as life advances there are peculiarities which belong to individuals and to families. One group thins as life goes on past forty; another group as surely takes on flesh; and the same traits are often inherited, and are to be regarded when the question of fattening becomes of clinical or diagnostic moment. Men, as a rule, preserve their nutritive status more equably than women. Every physician must have been struck with this. In fact, many women lose or acquire large amounts of adipose matter without any corresponding loss or gain in vigor, and this fact perhaps is related in some way to the enormous outside demands made by their peculiar physiological processes. Such gain in weight is a common accompaniment of child-bearing, while nursing in some women involves considerable gain in flesh, and in a larger number enormous falling away, and its cessation as speedy a renewal of fat. I have also found that in many women who are not perfectly well there is a notable loss of weight at every menstrual period, and a marked gain between these times.