56 OVER-NUTRITION AND UNDER-NUTRITION 



amount of nourishment which will most surely produce a loss of fat without 

 impairing the muscular condition have been carried on for years, and reached 

 their acme in the debates at the Congress of Internal Medicine in the year 

 1885, and in the literary war waged between Ebstein and Oertel. The views 

 were based rather upon theory than upon practical experience. Investigations 

 regarding metabolism during antifat cures had not yet been attempted. A 

 few years later when, independently of one another, F. Hirschfeld and v. 

 Noorden-Dapper worked out this problem experimentally, contradictions at 

 first resulted. The former found it almost impossible to produce a loss of 

 fatty tissue without a simultaneous decrease of the body albumin. The other 

 two authors proved by numerous investigations that this goal may be reached, 

 and even without special difficulty, provided the leap from a plentiful diet to 

 one of abstinence is not too sudden. All the authors who later devoted them- 

 selves to similar researches have confirmed this. The satisfactory result of 

 these studies of metabolism has had, it appears to me, great influence upon 

 the practical work of physicians, and has encouraged them — certainly not to 

 the detriment of the patient — to attempt careful antifat cures, where pre- 

 viously they refrained from them because in every antifat cure — even if only 

 transiently — the supply of body albumin was jeopardized. According to other 

 investigations in metabolism as well as in my own, and also according to later 

 researches of Dapper and myself, careful planning of the ingestion of nour- 

 ishment so that the albumin supply of the body will not be decreased may 

 obviate this danger, but by no means removes all other difficulties. For, in 

 numerous cases, it is evident that the muscular power of the patient must not 

 only be maintained but increased. This end also may be practically achieved, 

 and will crown the success of a thoughtfully carried out antifat cure. It pre- 

 supposes that the patient must become accustomed, from the beginning of 

 the treatment, to an increasing amount of bodily exercise. We must utilize 

 the well-known physiological fact that, if we exercise a muscle, it gains not 

 only in strength but also in bulk. It is true that investigations of metabo- 

 lism in which the combustion of albumin has been tested during dietetic 

 antifat cures with and without systematic, muscular exercise have not yet 

 been carried out; but we hardly require them, for clinical experience demon- 

 strates how readily strength and size of muscles may be increased during 

 dietetic antifat cures. 



Formerly (in opposition to the facts) we regarded the preservation of 

 the stability of the organic albumin in antifat cures as difficult, even impos- 

 sible. Yet, at the same time, it was not doubted that by forced feeding it 

 was very easy to accelerate not only the formation of adipose tissue but also 

 of the animate protoplasm of the body, and particularly to strengthen the 

 muscles. The proposition, however, is by no means so simple as it appears. 

 That albumin metabolism is diminished and IST-containing material accumu- 

 lates in the body on over-feeding with albuminates, particularly with fat, and 

 to a still greater degree with carbohydrates, had been long known from animal 

 experiments by Bischoff and C. v. Voit and their pupils. Investigations in 

 man— especially the researches of Bleibtreu and Krug— have confirmed this, 

 and Bornstein and Liithje in their latest studies in metabolism have demon- 



