66 OVER-NUTRITION AND UNDER-NUTRlTlON 



4. Massage and faradization of the muscles during the rest in bed ; careful 

 hydrotherapy to stimulate the circulation. 



For numerous cases, especially those in which excessive irritability of the 

 nervous system is prominent among the clinical symptoms, no more valuable 

 treatment can be outlined to-day than the Weir Mitchell-Playfair plan. But 

 it has been demonstrated that the diversity of the cases necessitates numerous 

 modifications. The other factors associated with hypernutrition- (especially 

 isolation, rest in bed, massage, etc.) are frequently not only unnecessary, but 

 actually a hindrance to success. The diet which Weir Mitchell proposed may 

 be modified as occasion requires. Any one conversant with the laws of nutri- 

 tion and with general therapy may with ease select what is suitable for each 

 individual case. 



My experience leads me to state that I frequently employ only limited 

 isolation, i. e., the removal of the patient from his usual surroundings and 

 activities, but rarely insist on prolonged rest in bed. In my opinion, the 

 latter should be avoided whenever possible, for reasons previously men- 

 tioned. 



The indications for forced feeding, according to the experiences of the 

 last twenty years, are present in functional neuroses combined with mal- 

 nutrition, whether the poor state of nutrition is to be looked upon as the 

 cause of the neurosis, or whether the neurosis by its influence on the intake 

 of nourishment and digestive processes produces secondarily a damage to the 

 nutrition of the body. In the former case, we can well hope to remove all of 

 the pathologic phenomena together with their cause. In the latter case we 

 are at least combating a symptom from which the disease constantly receives 

 new stimulus. 



Here also, as in the case of exophthalmic goiter — although not for the 

 same reasons — I must caution against immoderation. Many neurasthenics are 

 easily fattened, and, after six to seven weeks, may show a gain of 30 or 40 

 pounds in weight. But during such rapid augmentation of body-weight new 

 disturbances not infrequently appear which, in themselves unimportant, are 

 over-estimated and exaggerated by the suspicious neurasthenic and hysterical 

 patient. For this reason, I limit the acquisition of weight desired to about 

 30 pounds, which, according to the individual case, may take from four to 

 five weeks. Then a halt must be calkd, and after an interval, forced feeding, 

 if necessary, may be begun again. 



Group 3. In all individuals with a poor condition of nutrition it is im- 

 portant to determine whether this faulty nutrition has been the hindrance 

 to the full development of their power, to the natural building up of their 

 bodies (in children and young persons), to recuperation after excessive bodily 

 and mental labor, or to convalescence after diseases. The guide for the physi- 

 cian must be not only the present, but the thought of what the future may 

 bring. The various special indications cannot be individually described with- 

 out entering into the wide realm of general pathology. I should like to 

 repeat (see above) that for every person there is a different optimum of 

 nutrition. Only experience will enable the physician to estimate and recog- 

 nize this optimum in individual cases. He who trains himself from this point 



