THE TECHNIC OF OVER-NUTRITION AND UNDER-NUTRITION 71 



emphasized that occasionally the mere increase of the amount of albumin is 

 beneficial; for example, in preparation for true forced feeding, or, if there is 

 repugnance to great quantities of N-f ree food, during a " vacation period " of 

 from eight to fourteen days which the patient may have to take in his forced 

 feeding treatment. Under these conditions temporary forcing of the albumin- 

 intake at the expense of the N-free substances renders the body more receptive 

 to the later action of the true forced feeding. For these purposes the purified 

 albumin preparations, such as plasmon, etc., are more suitable than meat. 

 From 50 to 60 grams of plasmon may be given with advantage during the 

 day. There is no difficulty in administering this amount, as, in this period, 

 we no longer increase the N-free substance. During longer periods, however, 

 little can be expected from such an exclusive increase of the albuminates. 



Among the substances free from nitrogen we may choose between the 

 administration of fats or of carlohydrates, or may administer both in almost 

 equal proportions. In principle it is immaterial, as fat and carbohydrates 

 compensate for one another according to the law of isodynamics. One hun- 

 dred grams of fat are equal to 224 grams of carbohydrates, and vice versa. 

 As a rule the marked increase of carbohydrates is preferable, provided always 

 that they are better tolerated than fats. In some patients this is unquestion- 

 ably true, but in the majority certainly not. If we desire to add about 1,200 

 calories of N-free substances, we require either 129 grams of fat or 300 grams 

 of carbohydrates ; many other mixtures may be used ; for example, 200 grams 

 of carbohydrates and 40 grams of fat, or 100 grams of carbohydrates and 85 

 grams of fat. 



For more than ten years I have preferred to increase the administration 

 of fat, for I have found that a larger amount of carbohydrates — 300 to 400 

 grams a day — is not well borne for any length of time. AVhen, under the 

 constraint of treatment in an institution, the patient is forced to take the 

 large amounts of food which are necessary if we use the carbohydrates alone, 

 we see only too frequently, after the restraint is removed, a period of anorexia 

 during which much of the body-weight gained with so much difficulty is lost. 



Accordingly, the composition of the nourishment during forced feeding 

 should be about as follows : 



120 to 130 grams of albumin (490 to 530 calories). 



300 to 350 grams of carboh3'drate (1,230 to 1,435 calories). 



This nourishment (720 to 1,965 calories) forms the basis to which as 

 much fat may be added as is necessary to make the proposed calory total: 

 i.e., from 200 to 300 grams of fat (1,860 to 2,730 calories) or even more. 

 Frequently a portion of the required calory excess may be given in the form 

 of alcohol, whereby certain amounts of fat are protected from oxidation and 

 preserved for the organism (9.3 grams of alcohol protect about 7 grams of 

 fat from oxidation). 



The amount of water to ie added, provided special indications do not 

 necessitate exact regulation, may be according to the desire of the patient. 

 As a rule, if much carbohydrate is given the amount is greater than if much 

 fat is administered. 



