INDICATIONS FOR HYPERNUTRITION AND HYPONUTRITION 67 



of view possesses weapons against disease (existing and threatening) than 

 which there are none more effective. 



Of course in all of these cases, even more than in Groups 1 and 2, the 

 development of the muscles must be considered, for by the accumulation of 

 fat alone nothing is gained. Therefore, systematic muscular exercise must 

 be added to forced feeding. The form which this exercise takes is of minor 

 importance. I prefer exercise in the open air (walking, mountain climbing, 

 gymnastic exercises, games, bicycling, etc.), provided we are certain of not 

 overdoing, to massage or indoor gymnastics. Gymnastics with apparatus 

 deserve consideration only when exercise in the open air is contra-indicated 

 for special reasons, or when development of special muscle groups is desiraljle. 



As a rule, it is wise to regulate forced feeding and muscular exercise in 

 this third group of cases, so that only a gradual increase of weight results. 

 We are then much more certain of a permanent and substantial gain. In 

 cases belonging to the first and second group, increases in weight of about 

 12 to 15 pounds within four weeks — with certain exceptions (see above) — are 

 worth striving for, and sometimes, as in neurasthenics, particularly rapid 

 results are important as suggestive curative agents. But in cases of the third 

 group it is better to have this increase in weight distributed over months 

 instead of weeks. From this it may be further concluded that these persons, 

 who need not so much an instant recovery from a morbid condition as a general 

 strengthening of the body, should not be treated in hospitals or sanatoriums, 

 or only temporarily. Few can bear removal from the ordinary routine of daily 

 life for so long a time, for the air of the sanatorium is rich in psychical con- 

 tagion. The treatment, and especially the regulations for forced feeding and 

 slow increase of the body-weight, must therefore be planned according to the 

 patient's circumstances, occupation, habits, and position in life. With strict 

 regulations we are less likely to reach our goal than if the constraint of an 

 institution is abolished. Of course a complete change from the previous mode 

 of life which led to the unsatisfactory condition is the first step. Then we 

 can easily learn whether a simple increase of food without any special regula- 

 tion of its quality, quantity or distribution is sufficient, or whether any par- 

 ticular food must be added to the diet to make the success certain, and, lastly, 

 whether this addition should come from the albumin group, from fats or 

 from carbohydrates. 



B. UNDER-NUTRITION 



Antifat cures are undertaken almost exclusively in obese persons; rarely, 

 if ever, in persons normally or insufficiently nourished. What rule is to 

 guide the physician in the important problem : Is an antifat cure to be begun 

 or not? I desire to refute the opinion so frequently expressed that antifat 

 cures always belong to the so-called " weakening cures." The popular views 

 in regard to this are very exaggerated. I maintain positively that an anti- 

 fat cure begun for proper reasons — and provided that the choice of the 

 method, the rapidity with which it is carried out, and the loss of weight are 

 adjusted to the individual condition — ^never deserves the name of a " weaken- 

 ing cure," but may always be conducted without injury to the patient, and 



