INDICATIONS FOR HYPERNUTRITION AND HYPONUTRITION 65 



maiataining and developing the muscular tissue even by forced feeding so 

 long as the disease progresses. Nevertheless, forced feeding carried on per- 

 sistently is remarkably successful; the patients accumulate valuable reserve 

 material, and experience shows that they are much better than when exposed 

 to progressive emaciation by dietetic negligence. But though it is necessary 

 to promote the nutrition of the patient, it is not to be supposed that a very 

 energetic and rapid forced feeding is here indicated. Great care is neces- 

 sary; for patients who present severe forms of Graves' disease, and whose 

 nutritive condition has been correspondingly damaged, suffer also from car- 

 diac weakness. To maintain their balance of nutrition, they require upon 

 the average from 15 to 20 per cent, more food than a person in normal health 

 of the same weight and build, and of course if we are to attain an increase in 

 weight, still more food is necessary. But according to my experience, the 

 cardiac difficulties frequently increase if we proceed too rapidly with forced 

 feeding. Indeed the cardiac weakness which results may be dangerous. Last 

 year an able author reported a case in which, in a short time, an increase of 

 weight of 23 pounds was brought about by over-nutrition. In spite of this 

 desirable result, collapse occurred in which the patient succumbed. I believe 

 it cannot be doubted that this too rapid over-nutrition was responsible for 

 the unfavorable outcome. I have, myself, not seen such serious results from 

 over-nutrition in Basedow's disease, but I have observed exacerbations which 

 made me fear collapse. Hence, there is need of proceeding slowly in all 

 severe cases; we must be satisfied if at first only the rapid loss of weight is 

 stopped. When this has been accomplished, and the weight maintained for 

 several weeks, forced feeding should be again resorted to, but an increase of 

 about a pound a week should not be exceeded. 



Group 2. In functional nervous diseases. — ^We are indebted to S. Weir 

 Mitchell for having pointed out the deleterious effects in neurasthenic and hys- 

 terical persons of a poor state of nutrition — ^whether this dated from the onset 

 or developed in the course of the disease. He still further demonstrated, by 

 innumerable and convincing examples, that with systematic over-nutrition 

 (forced feeding) not only the state of the nutrition but also the activity of 

 the nervous system could be restored. 



Nearly twenty years have passed since the publication of these views by S. 

 Weir Mitchell and since that time forced feeding in the treatment of neuras- 

 l-henia and hysteria has become the common method of nearly all physicians. 

 The results thus attained are the foundation and the corner stone of the 

 reputation which numerous clinics and sanatoria have acquired in the treat- 

 ment of these cases. Eetrospectively speaking, this therapeutic accomplish- 

 ment which we owe to S. Weir Mitchell is of the highest significance. The 

 treatment of Weir Mitchell and Playfair, the latter of whom did a great 

 deal to popularize the method, consists of several factors : 



1. Isolation of the patient. 



3. Eest in bed, lasting according to the circumstances of the case from 

 one to several weeks. 



3. Over-nutrition; beginning with small amounts of food, and gradually 

 increasing to high values. 

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