OVER-NUTRITION AND UNDER-NUTRITION 



By C. v. NOORDEN, Frankfort-on-Main 



In modern therapy, dietetic cures are becoming more important from 

 year to year, particularly those which are intended to influence the entire 

 nutritive condition. Originally confined to the domain of internal diseases, 

 they have become familiar to the surgeon and g3TiecoIogist, and no less valu- 

 able to them than to the specialist in clinical medicine. It is vt^ell worth 

 ■vdiile to consider the salient features of these cures, without expecting that 

 nmcn that is new will be promulgated. For the fundamental laws are well 

 known, though their application to practice is eternally new. When the indi- 

 viduality of each patient has to be considered, the rules lose their supposed 

 uniformity and their diagrammatic aspect. Uniform and self-evident as the 

 method is when formulated in theory, in practice each particular dietetic 

 treatment brings with it new difficulties, new demands, and when the art of 

 the physician has succeeded, he invariably experiences the gratification of an 

 artistic triumph. 



1. CONCEPTION OF THE "CONDITION OF NUTRITION" 



When we speak of a person's " condition of nutrition " we mean, in the 

 first place, his development of adipose tissue; but not only this is to be con- 

 sidered, for the state of the muscles is of no less importance. Their devel- 

 opment is not always proportionate to the amount of fat. There are many 

 persons who are deficient in fat and weak in muscle, and many who are rich 

 in fat and strong in muscle. But there is a third class who are of strong 

 muscular power and deficient in fat, and a fourth who are lacking in muscle 

 and rich in fat. 



Of most importance, of course, is the condition of the muscles, all the 

 more so since with powerful muscles we expect a normal composition of the 

 blood and of the most important glandular organs. In every treatment by 

 which we hope to influence the " condition of nutrition " the protection of the 

 muscles must be kept in mind, or, stated more generally — the living and func- 

 tioning protoplasm of the body must be protected, and if possible improved, 

 so that the maximum of its development may be attained. 



How great is the amount of fat on the body — leaving out of considera- 

 tion pathologic leanness, pathologic obesity and special instances (see below) 

 — is of less significance. There is no generally accepted standard for a nor- 

 mal amount of fat. Between emaciation on the one hand and obesity on the 

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