60 OVER-NUTRITION AND UNDER-NUTRITION 



other conditions, particularly upon the healthy state of certain organs, for ex- 

 ample the heart and the kidneys. To this we shall refer later. But very often, 

 without our interference and against our will, our food produces the character- 

 istics of hyponutrition. This occurs in many diseases. We are unable to main- 

 tain the balance of nutrition either because patients refuse to take a sufficient 

 supply, or because diseases of certain organs (for example, the stomach) 

 necessitate a limitation. In acute diseases which run a rapid course the dan- 

 ger is not great, for what has been lost is rapidly regained in convalescence. 

 But in chronic diseases the body is often more weakened and damaged by con- 

 tinued under-nutrition than by the disease itself. It then becomes one of 

 the most important duties of the physician to increase the amount of food 

 at least to the point of maintenance, and, if possible, to make up what has 

 been lost by forced feeding. He will then often have the pleasure of noting 

 that not only does the state of nutrition improve, but that this improvement 

 acts favorably in the cure of the disease. In some maladies, for instance, in 

 not too far advanced tuberculosis of the lungs, this is the rule. 



At least as frequently as in actual disease we meet persons who are really 

 not ill but under-nourished. This results from caprices of appetite, from 

 unfounded fear of injury from ihis or that food (for example, fat substances), 

 from disturbances of appetite which are slight or which are taken too seri- 

 ously, from poverty, etc. Thus they have become accustomed to a too slight 

 ingestion of nourishment. Sometimes this is habitual from youth, and such 

 persons if left to themselves never attain the acme of nutrition (muscular 

 and fatty tissue) of which they seem capable, judging from their constitution 

 and build. Adipose tissue is scant, and the muscles, no matter how suscep- 

 tible of development, and no matter what efforts are made to strengthen them 

 by exercise, continue weak, for everything that is attempted is frustrated by 

 the oxidation-processes 'of the body. 



Others first manifest the symptoms of chronic under-nutrition after they 

 have reached adult life. These are mostly persons in whom there is a neuro- 

 pathic taint, and in whom the various forms of nervous dyspepsia develop. 

 Still others have become neurasthenic and hysterical only in the struggle for 

 existence against adverse circumstances. Organic causes which would pre- 

 vent a sufficient ingestion of food are not present, but manifold nervous dis- 

 turbances interrupt the distinctive connection between actual food-require- 

 ments (tissue hunger) and appetite (gastric hunger). Gradual loss of weight, 

 disappearance of adipose and muscular tissues, lessening- of the bodily and 

 mental powers, are the inevitable consequences. These patients, to the detri- 

 ment of their health, often seek a cure by unsuitable means, by gymnastic 

 exercises and sports, by mountain climbing, by exhausting cold-water cures 

 (frequently in so-called nature-cure institutions), where they hope to build up 

 their nervous system. This acts at first like a whip, apparently increasing 

 and stimulating their activitiest But the oats are lacking, and in a short 

 time there is a relapse to the former condition. The treatment is all the more 

 harmful because the food, during the time spent in these exhausting cures, 

 is weakening rather than strengthening. The patients and their " Natural- 

 Healer " proceed from the view that a too p/of use animal diet has disordered 



