[Footnote 27: Those who are interested in fossil words will find many curious confirmations of the connection between weight and good health and good humor. A typical illustration is the word buxom, derived from the German biegsam, which means "ready to obey," from the original significance of being ready to bend, that is bendsome. In our day it has come to have quite a material rather than an ethical significance. A buxom woman is one who is round and full of form and while she usually also is cheerful and tractable, the two ideas are not necessarily connected. It is curious that what was originally the obedient wife should now have become the stout and healthy wife, as if stoutness and healthiness were somehow inseparably connected with the preceding idea so that gradually one portion of the meaning was lost sight of and now only the physical significance remains.]
Thinness and Discontent.—In general, it is well understood that thin people are likely to be more gloomy and discontented than those of stouter build. The pessimists of the world have usually been lank and lean. Shakespeare, in "Julius Caesar," has the great Roman declare that he likes not "the lean and hungry Cassius," and that "discontent is bred in such bodies." The issue shows his prophetic power. Discontent with life is much more likely in thin people than in stout. Most suicides are under-weight. Where nutrition is under the normal, digestion is sure to be poor because the digestive organs themselves suffer even more than others from lack of food, apparently giving up some of their own substance at the call of other tissues; sleep is nearly always disturbed, constipation is almost the rule, and muscular action becomes distasteful. While in our day we hear much of people overeating, the nervous specialist finds that many of his patients are undereating. [{298}] These patients grow out of many discomforts, dreads, and symptoms that often seem, even to the physician, to be due to organic change, when they take on enough weight to relieve them from the incessant calls for more nutrition to which insufficient food has made them subject.
Physical Disadvantages of Thinness.—There are many dangers that go with thinness besides the tendency to that irritability of the nervous system which we have come to associate with neurotic symptoms. It has long been known that a person who is under weight is much more likely to contract tuberculosis than a normal individual. From carefully selected statistics, the large insurance companies have determined, that it is far more dangerous to insure a man who is twenty pounds under weight and who has no family heredity of tuberculosis than to insure a man with a family history of tuberculosis on both sides of the house, provided he is well up to or above the normal weight, and is not living in special conditions of danger from contagion. It is contagion and not heredity that plays the most important role in tuberculosis, and the element that is still more important is that of vital resistance. Every adult of thirty years or over has probably at some time had tuberculosis, for traces of its presence are found in the bodies of all adults who come to autopsy. Seven-eighths of the human race are, however, able to resist, and among these seven-eighths by far the greater proportion are those who are above normal weight.
Of course, this matter of the relation of normal weight to good health did not escape the acute observation of the old physicians. Hippocrates, to take the first and greatest of them, realized that while excessive eating and drinking was serious, there were many people who suffered from not eating enough. One of his aphorisms runs, "A slender and restricted diet is generally more dangerous [manifestly he means to both the well and the ill] than one a little more liberal." He appreciated, too, the fact that while the old may restrict their diet with more or less impunity, this practice may be, and indeed is likely to be, more serious in young people. He has marshaled the ages and stated the effects of a low diet on them very definitely:
Old persons endure fasting most easily, next adults; young persons not nearly so well, and infants least of all, especially those who are of a particularly lively disposition.
Discomfort Due to Lack of Fat.—Many of the vague discomforts of the internal organs seem to be due to a lack of fat cushions round them, and fat blankets to keep them from being too much subjected to the vicissitudes of external temperature. Anyone who has noted in a series of cases the difference between the condition of patients suffering from a slightly movable kidney when they are well up to weight, and when, on the other hand, they are considerably reduced in weight, will have the significance of the first of these conditions brought home very clearly. Most of the people who suffer much from cold in winter are greatly benefited, as might be expected, by a blanket of fat. It is rather easy to grow accustomed to carrying ten additional pounds of fat when ten additional pounds of clothes would be an insupportable burden. Some fat people are prone to complain of the cold. These are not the plethoric but the anemic. This latter class often have a sluggish circulation, besides a lack of hemoglobin. As a consequence of this their [{299}] oxidation processes are slow and imperfect, and this is one of the reasons for the over-accumulation of fat. The healthy individual with normal heart and normal blood-making apparatus will always be ever so much more comfortable with a reasonable panniculus adiposus and fat cushions and coverings for the internal organs.
Muscular Weakness and Discomfort.—There are a number of pains and aches occurring in lean persons that are due to nothing else than the weakness of muscle consequent upon the poor nutrition of their muscular tissues. Muscles which do not receive as much nourishment as they should, must necessarily be weak, and if asked to do much work they will resent it. Ordinarily it is not realized how much work is required even for such common muscular efforts as those that are needed to hold the body erect, or to keep it in a stooping position at a definite angle, or to move around on the feet.
I have seen patients lose their aches and pains, and become quite capable of standing weather changes and ordinary hard muscular labor without discomfort, simply as the result of a decided gain in weight. All that was needed was the persuasion to eat more, and especially to eat a full breakfast, the meal likely to be neglected. In some persons, appetite will only return after the correction of constipation and insistence on a certain amount of outdoor air every day, not necessarily exercise—for bus riding or the open cars are excellent appetizers.
Eating Enough.—It is very difficult to persuade some people to eat enough! They have all sorts of excuses. They rather pride themselves on the fact that they do not eat much. Persons who are twenty pounds under weight will calmly tell you that they do not need more than they eat. They are actually in debt to that extent to their tissues, yet they are persuaded that they are paying nature's claims in full. Sometimes the excuse is that they have heard, or read, of how much harm is done by overeating; they have taken to heart the phrase that people are digging their graves with their teeth, and so they are actually cultivating the habit of undereating instead of allowing their instinct for food to manifest itself. Many are found to be following the good old saw of getting up from the table hungry. The inventor of it is not known, but quite unlike the inventor of sleep, it would have been a great blessing if he had kept it to himself by patent right.
After a time habit for these people becomes second nature, and it is hard to get them to eat enough. When people undereat it is the digestive organs that, in my experience, always suffer the most. As a consequence, the appetite decreases because of gradually acquired lack of vitality in the digestive system, its nutrition having been lowered by drafts upon it from other portions of the body. Quite contrary to what is told in the old fable, the stomach apparently is not selfish and does not keep the lion's share for itself. The decrease in the amount of food brings on a decrease in digestive power.