1 8 GENERAL PART 



Investigations of the metabolism in premature development as the result 

 of suprarenal cortical, sexual glandular, and epiphysial tumors have not as 

 yet been made. In severe diabetes mellitus, as will be told about in detail in 

 Chapter XIII, the caloric production in the rest-fasting experiments is not 

 essentially increased; the caloric and oxygen requirements are increased, 

 correspondingly to the loss of sugar and of ketone bodies. According to 

 the investigations up to the present, a considerable influence on the funda- 

 mental exchange is to be attributed only to the thyroid gland. It seems 

 to me, however, that for a correct appreciation of the influence that the duct- 

 less glands exercise on the metabolic processes and nutritional conditions, 

 it is just as important that we consider the endogenous factors as well as the 

 exogenous factors. By fundamental exchange we mean, as is known, the 

 amount of the carbonic-acid production and of the oxygen requirements, or 

 of the heat production, on ruling out of digestion and muscular work. If 

 we calculate the fundamental exchange per kilogram of body weight, we 

 find in (grown) small and thin individuals higher values than in (grown) 

 large and fat individuals. In youthful individuals the fundamental exchange 

 is relatively larger than in adults. In the small individuals the variations to 

 which it is subject are ordinarily only very slight. The fundamental ex- 

 change is a measure for the work that in a resting fasting organism is per- 

 formed by the heart, the glands, the nervous system, etc., including that 

 which is furnished by a certain muscular tonus that cannot be excluded. 

 That the thyroid enormously influences the fundamental exchange may be 

 readily understood when we consider that in Basedow's disease the organs 

 are in a condition of marked excitement, while in myxedema the vegetative 

 functions are markedly reduced. A certain influencing of the fundamental 

 exchange is to be expected also on the part of the other ductless glands as 

 they too influence the vegetative nervous system in manifold ways, so far 

 as its condition of irritability is concerned, even if their influence does not 

 cause such distinct effects. But also the exogenous factor of the exchange 

 is influenced by the ductless glands more or less pronouncedly. I have 

 reference to the unrest and mental irritability of Basedow's disease and to the 

 apathy and lack of interest of the myxedemic. In tetany we find in addition 

 to the increase in the vegetative functions also an extraordinary influencing 

 of the exogenous factors through the fibrillary twitchings and through the 

 spasms. Also as far as the sexual glands are concerned does an exogenous 

 factor come into play; for instance, in eunuchs there are absent the stimulus 

 to motion and the animation of the normal man. All these are factors that 

 are of great importance for the regulation of the total exchange and for the 

 condition of nutrition. 



Even more significant appears to me the following circumstance : That a 

 normal grown man retains the same bodily weight for years depends on a 

 correct relation between assimilation and dissimilation assured by such 



