By his studies in alimentotherapy, which owes its introduction to Lis efforts, von Leyden has achieved immortal fame in medicine. The same may be said of S. Weir Mitchell, who at an earlier date published his well-known food and rest cure in the treatment of neurasthenia. Von Noorden followed with classical monographs on diseases of metabolism, showing that an adequate nutrition is of the greatest importance in the treatment of chronic affections. Many clinicians, including myself, followed in the footsteps of the above authors. In 1893 I wrote an article entitled "Dietetics in Diseases of the Stomach,"2 and later another, "The Diet of Dyspeptics,"3 in which I emphasized that sufficient nutrition and frequently, in fact, overnutrition were essential in the cure of a great many invalids.

This proposition at first sight seems so self-evident that a discussion of this subject would hardly be considered necessary. In reality, however, even physicians frequently sin against this fundamental truth of dietetics i.e., sufficient alimentation. I have, therefore, thought it worth while to report on this subject from an extensive clinical experience, in order to illustrate the great importance of dietetics and its application.

1 Read before the American Gastroenterological Association, May 14th, 1903, at Washington, D. C. The American Journal of the Medical Sciences, August. 1003.

2 Medical Record, June 24th, 1893. 3 Ibid., January 1st, 1898.

1. By the term sitophobia we understand a condition in which too little food is taken on account of fear. This fear relates to pains or disagreeable sensations in the digestive apparatus arising after meals. To avoid these, patients prefer not to eat, or rather to eat as little as possible. Sitophobia is most common in chronic affections of the digestive system, accompanied by pains (gastralgia and enteralgia). These are usually ascribed by the patient to various foods, and, in order to avoid the pains, they exclude at first the coarser and later even easily digestible articles from their dietary, taking finally only small quantities of milk or broths. Sometimes sitophobia arises in consequence of an abnormal sensibility of the gastric mucous membrane (hypereasthesia veutriculi). This is but another variety of the cases just described; for even if in hyperaesthesia of the stomach no severe pains are experienced, yet the ingestion of food causes disagreeable sensations which the patient is anxious to avoid.

A further group is formed by those cases in which patients from false ideas, in the absence of pain, avoid food or limit its amount. Thus especially sufferers from intestinal disorders,1 afflicted with constipation or diarrhoea, are afraid to eat heartily, because they think that the condition would be aggravated. To this class also belong all cases in which the patient for some reason or other on account of a certain ailment cats too little in quantity or variety, as, for instance, gouty people avoiding all meats, obese persons who do not take fats or carbohydrates, thereby injuring the organism.

1 "Sitophobia of Enteric Origin." Journal of the American Medical Association, June 15th, 1901.

R. von Hoesslin1 regards sitophobia as a psychical condition. He says: "Such fears are not possible in perfectly normal people; for the expression 'phobia' presupposes the existence of an abnormal fear, based upon false ideas. If this fear is not abnormal, but justifiable - if, for instance, a patient suffering from acute enteritis is afraid to eat cabbage or prunes, or if a person who is always affected with urticaria after partaking of strawberries or lobster avoids these dishes - then we do not have to deal with a so-called phobia, but with a very sensible train of reasoning; but if this fear is abnormal, some psychic change has taken place. Sitophobia is, therefore, like all other phobias, of cerebral origin."

With reference to these remarks of von Hoesslin, I would reply that sitophobia is certainly found in people who do not suffer from any psychic disturbance. The patients are afraid to eat because they have pain afterward. This fear is justifiable; but in order to effect a cure it must be overcome, and, therefore, the treatment of this symptom (sitophobia) plays an important part.

Sitophobia, if left alone, leads to a partial, sometimes nearly total, inanition. A consideration of these conditions is, therefore, not out of place here.

2. Inanition means loss of strength owing to deficient nutrition. This expression was first, used by Chossat2 to designate the atrophy resulting from total abstinence. According to Samuel,3 we must distinguish between complete and incomplete inanition.

1 "Bomerkungen zu Dr. Max Einhorn's Artikel fiber Sitophobie intestinalen Ursprungs." Zeitschr. f. diatetische u. physikalische Therapie, 1902, Bd. v., p. 529.

2 "Recherches experimentales sur 1'inanition," 1835.

3 Eulenburg's "Encycl. der Med.," Bd. x., p. 320.

Complete inanition of short duration (twelve to twenty-four hours) is often noted, as, for instance, in travellers who do not find an opportunity to obtain food during a voyage; also on fast days that are observed by many persons for religious reasons.

Signs of weakness and various nervous symptoms (pains in the neck, severe headaches, vertigo) develop early and are especially marked after severe exertions. Prolonged periods of fasting are undergone either by shipwrecked people or by special professional fasters. The latter have been made the subject of important scientific investigations during the last twenty to thirty years. Our knowledge of metabolism during inanition is now almost complete, thanks to the labors of Zuntz and Lehmann,1 Luciani,2 and others.

It has been shown that during complete inanition the organism takes up as much oxygen as during normal rest - i.e., after digestion is completed - for during the latter state an increased amount of oxygen is utilized, owing to the augmented activity of the digestive apparatus. During inanition the body consumes its own substance in order to maintain its temperature and its chief functions. It lives on its own flesh and fat and does not economize any more than normally.