INDICATIONS FOR HYPERNUTRITION AND HYPONUTRITION 63 



A. OVER-NUTRITION 



Group 1. In chronic wasting^ diseases. — Considered historically, over- 

 nutrition in pulmonary tuberculosis, or rather in tuberculosis of any type, 

 is to be placed in the front rank. Even the old custom of administering cod 

 liver oil in " scrofula " and tuberculosis belongs to this category. We have 

 gradually been forced to acknowledge that its action is not specific but due to 

 the fat vfhich it contains, that is, to its high nutritive value. Brehmer vi^as the 

 first, and Dettweiler the next, systematically to employ over-nutrition in 

 tuberculosis. The success of this method is surprising, as any one can see in his 

 daily experience. By over-nutrition, as now carried out in all institutions 

 for the cure of pulmonary tuberculosis, in hospitals, in the homes of the 

 patients, or wherever it may be attempted, we do not attain a cure for tuber- 

 culosis, but the favorable results which have been attained up to now in treat- 

 ing tuberculosis are inseparably associated with over-nutrition. Here, better 

 than anywhere else, it may be noted how beneficially the improvement in the 

 general nutrition acts upon the resistance of the tissues. I have already 

 alluded to this elsewhere, and, after further experience, I wish to reiterate 

 that the modern treatment of pulmonary tuberculosis by over-nutrition is 

 in danger of accomplishing too much. Pulmonary patients who had formerly 

 been emaciated sometimes after treatment become corpulent; this is not to be 

 regarded as desirable, but as a disadvantage. For obesity always throws in- 

 creased work upon the respiratory and circulatory organs, and in this way 

 makes demands upon the diseased organ which it should be spared. But apart 

 from these extreme cases, over-nutrition in pulmonary tuberculosis may be 

 designated as one of the most valuable agents in the realm of dietetic therapy. 



Over-nutrition as a prophylactic measure produces even more favorable 

 results than in tuberculosis that has already developed. It is especially valu- 

 able in children and adolescents who have suffered from a previous tubercu- 

 lous disease of the glands, Joints and bones — and hence are liable to a later 

 " pulmonary tuberculosis " — as well as in those who without such preceding 

 affections are likely to become tuberculous on account of general weakness 

 and hereditary predisposition. The majority of consumptives attacked in 

 the second or third decades of life have been, as Brehmer once correctly re- 

 marked, small eaters from youth. Under circumstances such as these the 

 early resort to forced feeding, combined with exercises to harden the mus- 

 cles and properly develop the body, is one of the most beneficent and grateful 

 tasks of the family ph5'sician, all the more grateful if this method be insti- 

 tuted early in life when the body is still in the stage of growth and the 

 accumulation of muscular tissue takes place more readily than in later years. 



Cures based on forced feeding practically play a less important role in 

 all other chronic wasting diseases than in tuberculosis. Most important, per- 

 haps, is over-nutrition in syphilis, a disease which frequently, and especially 

 in its early stages, markedly influences nutrition, and in its subsequent course 

 (in the so-called tertiary forms) almost invariably produces extensive tissue- 

 disintegration. The old custom, originating centuries ago, and not yet rooted 

 out, was to place these patients upon a scant, meager diet, and to weaken them 



