70 OVER-NUTRITION AND UNDER-NUTRITION 



success in this field, and frequently does more harm than good. There is no 

 single "best method" of over-nutrition^ and no single best method for the 

 removal of fat, but there is for each individual case one and only one best 

 method. It must be constructed by the physician upon the scientific laws of 

 nutrition, whether a celebrated name is attached to the method or not. Hard 

 and fast dietetic rules are most widely developed in the realm of antifat cures. 

 There are obesity cures according to Harvey-Banting, Oertel, Ebstein, Hirsch- 

 feld, Schweninger, Kisch, Pastor Kneipp, etc. 



I do not intend either in over-nutrition or in under-nutrition to dwell 

 upon the individualities of the methods, but I shall emphasize the main points. 



A. THE TECHNIC OF FORCED FEEDIKG 



Over-nutrition presupposes that the ingestion of food is to be greater 

 than the requirement. How great the surplus of food is to be depends upon 

 the rapidity with which the process is to be carried out. Apart from partieu-' 

 lar indications (for example, in Graves' disease, see above) the capacity of the 

 digestive organs should decide this question. 



How the requirements of the patient can be approximately determined 

 from the body-weight has been related. 



According to the calculations which I made in a large number of cases 

 treated by forced feeding I obtained the following results (I must admit in 

 this connection that the figures had not been theoretically determined prior 

 to beginning forced feeding, but were gained empirically during the treat- 

 ment) : With a daily excess of food of about 500 to 800 calories, we get an 

 increase of weight of from 600 to 1,000 grams in a week; with a daily in^ 

 crease in food of 800 to 1,200 calories, weight increases from 800 to 1,300 

 grams per week; with a daily excess of food of from 1,300 to 1,800 calories, 

 weight increases from 1,200 to 2,000 grams per week. 



Quite properly the question arises, not only how many calories -should the 

 food contain, but also how much albumin and If-free substances are included 

 in it. 



The albumin bodies theoretically considered have no great value in in- 

 creasing weight. The average albumin content of ordinary diet (100 to 110 

 grams) may be somewhat increased in forced feeding, but hardly more than 

 50 grams. Still larger quantities of albumin can be utilized only in excep- 

 tional cases as the bulk of the food becomes too great, and also because all 

 albuminous foods produce satiety to a marked extent. Even the preparation 

 of purified albumin products (casein, nutrose, tropon, plasmon, roborat,_ aleu- 

 ronat, ergon, etc.) has not changed this. From 20 to 30 grams during the 

 day are useful ; larger quantities, if their use be prolonged, as a rule spoil the 

 appetite, whether we administer them in milk, soups, sauces, pap, in the form 

 of pastry or otherwise. No matter to what form we add the 50 grams of albu- 

 min, which I have designated as the most that can be used, it is certain that for 

 increase of weight little is gained by this ; it only furnishes about 205 calories. 



I hold that in general, allowing for exceptions, the daily administration 

 of from 120 to 130 grams of albumin is quite sufficient. My best results 

 were arrived at by keeping within these limits. Nevertheless, it must be 



