THE TECHNIC OF OVER-NUTRITION AND UNDER-NUTRITION 75 



treatment is favored by limiting the amount of water cannot be pronounced 

 unqualifiedly incorrect. We must be quite clear that this fact has no bearing 

 on the relation between the administration of water and decomposition of 

 fat — as taught by Oertel and Schweninger — ^but that water has its effect by 

 influencing the intake of food. Many persons eat decidedly less when forbid- 

 den to take as much fluid as they have been accustomed to doing. They cer- 

 tainly eat less if the simultaneous ingestion of fluid and solid food is for- 

 bidden. The lessened ingestion of food will then promote the disappearance 

 of body fat. But this result cannot always be counted upon, for among the 

 obese we meet many whose appetite is not influenced in the least by limiting 

 the intake of .fluid. They naturally remain fat, or even deposit more fat, no 

 matter how much they are tormented by the thirst cure. 



I have formulated the present status of the question in the following state- 

 ments : ^ 



1. A limitation of the intake of fluid, according to Oertel and Schwen- 

 inger, has not the slightest influence upon the decrease of body fat or upon 

 the increase of fat metabolism. 



2. The primary effect of limitation of fluid upon body-weight depends 

 upon the losses of water from the blood and the tissues. This may be utilized 

 therapeutically : 



(a) To improve the circulatory conditions in endangered failure of the 

 heart (in cases of valvular disease, disease of the heart muscle, arteriosclero- 

 sis, contracted kidney) ; 



(&) In patients with a tendency to immoderate production of sweat, and 

 for the purpose of combating hydrorrhea ; 



(c) In some patients it is a valuable auxiliary remedy through suggestion. 



3. The influence of the limitation of water upon fat metabolism, particu- 

 larly in decreasing the amount of fat, is only indirect, and comes into ques- 

 tion only under special conditions, namely: 



(a) If, by decreasing the fluid intake, the circulatory disturbances pres- 

 ent are to be compensated; there may be then a possibility of favoring the 

 combustion of fat by muscular exercise. 



(&) When, by decreasing the fluid intake, the appetite of the person for 

 fat-producing foods is diminished. This result may appear in a marked 

 degree, more frequently in slighter degree, or not at all. 



4. When no special indications are present the intake of water is not to 

 be limited in the obese, as, without this, we attain the same end afld the 

 limitation of water in such cases is only an unnecessary hardship for the 

 patient. 



That, in antifat cures, under-nutrition is not the only agent to be em- 

 ployed, but that this is to be assisted by systematic muscular exercise, has been 

 reiterated. I shall not enter into individual points, but will only refer to 

 other chapters of this book in which the treatment of obesity has been explic- 

 itly described. 



Here it is only necessary to indicate the important points that should 



1 Therapie der Gegenwari, April, 1900. 



