64 OVER-NUTRITION AND UNDER-NUTRITION 



by laxative drinks. In contrast to these old usages, an excessive or forced 

 administration of nourishment has shown itself to be much more efBcacious. 

 Many protracted cases of tertiary syphilis can be cured only when the body 

 has been thus strengthened by over-nutrition. 



Diabetes mellitus may also be counted among the chronic wasting diseases 

 naturally within certain limitations, as there are numerous cases of diabetes 

 mellitus in which, vice versa, definite relations to obesity exist. Where this 

 is not the case (as in the severe forms of diabetes, particularly that occurring 

 in youth), emaciation is combined with the disease, partly as the result of 

 losses in sugar, and partly as the result of peculiarities of the diet. To inter- 

 fere, to replace by over-nutrition not only what has been lost and if possible 

 to raise the patient's state of nutrition above the average, is important, for 

 experience teaches that a good state of nutrition will often avert many of the 

 dangers of the disease. 



Diabetes insipidus must also be mentioned. Unfortunately, we know 

 little regarding the pathogenesis and the minute disturbances of metabolism 

 which take place in this disease. The most conspicuous symptom in all severe 

 cases is the decided emaciation and loss of strength, which cannot be reason- 

 ably explained from the loss of water by the body. If we leave out of con- 

 sideration the gradual restriction of the intake of water, and a few purely 

 symptomatic drug indications, the especial and systematic improvement of 

 the nutrition by a long-continued, forced diet is the only measure which 

 promises success. In view of the rarity of these cases, I shall briefly report 

 a case under treatment by me three years ago for diabetes insipidus. The 

 disease occurred in a man aged fifty, and was credibly reported to have fol- 

 lowed a severe shock sustained in a railway accident; it had existed for about 

 fifteen months. The patient's previously normal state of nutrition had suf- 

 fered acutely during this time, the loss in weight amounting to more than 

 25 kilograms. The daily amount of urine varied between 9 and 13 liters. In 

 this case, by a plentiful addition of cream and butter to his diet (between 250 

 and 300 grams of milk fat daily), weight was increased 20 kilograms within 

 four months. After the first six weeks, the urine had already diminished to 

 between 5 and 6 liters, and, after two months more, to 3 to 4 liters. The once 

 markedly debilitated patient had, in the meantime, become strong again and 

 fully capable of working. He continued strong until attacked the following 

 winter by pneumonia to which he succumbed. According to the statements 

 of his relatives there had been no increase in the amount of urine. 



Finally, among the chronic wasting diseases, we must mention exoph- 

 thalmic goiter {Basedow's disease). Probably from a thyreogenous auto- 

 mtoxication (Mobius, Pr. Miiller, A. Magnus-Levy) an increase of the proc- 

 ess of metabolism occurs, i. e., an increase both in the assimilation of albumin 

 and m the combustion of fat. In consequence of this, if the patients take 

 . only the amount of food which is the average for normal persons, this proves 

 msufficient, and they therefore consume their own body substance (protoplasm 

 and fat). Only by over-nutrition can we safeguard them from this. By over- 

 nutrition_ it is possible at least to conserve the fat, or we may even hope to 

 mcrease it. According to the researches of Pr. Miiller, we cannot count on 



