An insufficient combustion of fat with the consequent proportion ate accumulation of fat in the body as compared with the fat-forming substances ingested with the food seems to depend also upon the con dition of the blood in which its contained haemoglobin is diminished, whether by a lessened number of blood corpuscles in general or by a smaller amount of haemoglobin in their normal number, in anemia and chlorosis. The restriction of the oxidation processes in conse quence of the slighter absorption and distribution of oxygen would partly explain the experience of physicians that a rapid development of fat occurs as an unwelcome symptom of chronic ill-health, in the early stages of grave diseases, in pulmonary phthisis, scrofulosis, secondary syphilis, pernicious anaemia, etc., in which cases of course the fat soon disappears again; and in like manner that after a severe sickness and great losses of blood not rarely a high degree of corpu lence develops. Since in cases of convalescence from typhoid fever, scarlatina, etc., the attempt is frequently made to counterbalance the losses in a hasty manner by an ample supply of food, while there is no particular muscular activity, such nutritive processes resemble the fattening of animals which have first been partly deprived of their albumin by fasting and then are rapidly made fat by the forced feeding.
Under the conditions named—insufficient bodily activity and ex cessive rest, too much sleep, a life free from care and excitement, pronounced phlegmatic temperament, anaemia and loss of albumin— the possibility exists that even under a mixed diet containing enough albumin and fat-forming substances an increase of the body fat will gradually take place. The fat production is quite inordinately en hanced, however, when, besides such substances, fat, starch flour, sugar, etc., are ingested in large quantities, as is done by gourmands, great eaters, and by women (cakes, candy, etc.). This is true par ticularly of excessive beer drinking, by which usually so large a quan tity of fat-forming substances is taken into the body that it is no longer possible to burn them up completely even during laborious muscular activity, as in the case of brewers, bakers, butchers, etc.
As regards the alcohol in such cases or in general, the investiga tions are still insufficient to show how it acts on the combustion of fat. According to the investigations of Forster, J. Munk, and others, if used in moderate, non-intoxicating quantities it lessens the excre tion of urea and also (Zuntz and Geppert) that of carbonic acid; hence it acts similarly to carbohydrates and fat, as, being burned up in the body, it may save an equivalent amount of albumin and fat. But it differs altogether from the latter nutritive materials, when con sumed in larger intoxicating amounts, in that it increases the decom position of albumin in the body and must lead to a correspondingly augmented fat-formation from the latter. In this respect the alcohol
ingested with large quantities of beer and that contained in brandy are absolutely identical, and the fatty degeneration of the various cel lular elements usually occurring in drinkers bears out this statement; only the large amount of carbohydrates in the form of dextrin, mal tose, etc., ingested with an over-abundant consumption of beer leads to an even greater deposition of fat, as observed chiefly in countries where beer is the favorite beverage. To these facts and their sequels I endeavored to call special attention fifteen years ago in my " Manual of the General Treatment of the Circulatory Disturbances" (first edi tion, 1884).
In this connection mention should be made also of the ingestion of fluids in general and their influence upon the decomposition of fat. I first gained the experience in 1875 in my own person, and since then have observed in numerous patients under conditions which admit of no cavil, that the involution of fat-forniation, reduction of obesity, takes place in the shortest time when little fluid is taken, while the weight 'decreases more slowly or rises again when the amount of liquids is increased. I have attributed the cause largely to unfavor able circulatory and oxidation processes, especially when in conse quence of an excessive accumulation of fat there have resulted cir culatory disturbances—congestions—which are always unfavorably influenced by the ingestion of fluids. Besides we know from the investigations of Voit, cited by Lorenz in his observations, that the decomposition of albumin increases under a free ingestion of water, when the particles of the albuminous solution are carried past the cells by a more active flow of the tissue juices. When the water sup ply is limited the decomposition of albumin would be diminished and, as the power of the cells is not yet exhausted by the slight de composition of albumin, the fat distributed in the lymph current might undergo combustion. The loss would then later on be made good by the fat passing from the adipose tissue into the lymph cur rent. In this process it is self-evident that it is never organ albumin but only circulating albumin which undergoes combustion, in the same way as body fat is never oxidized without having first been dis tributed in the lymph current. On the other hand, according to this explanation, even when the ingestion of water is increased a lesser combustion of fat would occur, since it has been demonstrated by Voit, J. Munk, and others that under those circumstances more albu min is decomposed by the cells, and so new fat might form from the decomposition products of the albumin which are rich in carbohy drates, or else the fat-forming substances contained in the food would be changed in larger quantities into fat by their oxidation.