As to quantity, it suffices to say that while by lessening food we may easily and surely make people lose weight, we cannot be sure to fatten by merely increasing the amount of food given; something more is wanted in the way of digestives or tonics to enable the patient to prepare and appropriate what is given, and but too often we fail miserably in all our means of giving capacity to assimilate food.  As I have said before, and wish to repeat, to gain in fat is, in the feeble, nearly always to gain in blood; and I hope to point out in these pages some of the means by which these ends can be attained.

Note.—­The statements made on page 21 and the following paragraphs about obesity in England and with us are no longer exact, but have been allowed to stand in the text as recording facts true at the time of writing them, in 1877.  At the present a medical observer familiar with both countries must note several decided changes:  more fat people, more people even enormously stout, are seen with us than formerly, and fewer of the “inordinately fat middle-aged people” in England than used to be encountered.  With us the over-fat are chiefly to be found among the women of the well-to-do classes of the cities, and from thirty years old onward.  They persecute the medical men to reduce their weight, and the vast number of advertisements of quack and proprietary remedies against obesity indicate how wide-spread the tendency must be.

Among women somewhat younger, as indeed among men, the American observer whose recollection takes him back twenty-five years must note a more hopeful change, a very decided average increase of stature, not merely in height but in general development.  This change is to be seen throughout the whole country, and must be taken first as a sign of improved conditions of food and manner of life, and next, if not more largely, of the new interest and partnership of girls in the wholesome activities of field and wood.

CHAPTER III.

On the selection of cases for treatment.

The remarks of the last chapter have, of course, wide and general application in disease, and naturally lead up to what I have to say as to the employment of the systematic treatment to describe which is my chief desire.  Its use, as a whole, is limited to certain groups of cases.  In some of the worst of them nothing else has succeeded hitherto, or at least as frequently.  In others the need for its application must depend on convenience and the fact that all other and readier means have failed.  It is, of course, difficult to state now all the groups of diseases in which it may be of value, for already physicians have begun to find it serviceable in some to which I had not thought of applying it,[11] and its sphere of usefulness is therefore likely to extend beyond the limits originally set by me.  It will be well here, however, to state the various disorders in which it has seemed to me applicable.  As regards some of them, I shall try briefly to indicate why their peculiarities point it out as needful.