THE FOOD REQUIREMENT OF THE SICK 21 



are sharply contrasted), the saving of albumin by a superfluous calory addi- 

 tion is not divested of its therapeutic importance. Where a simultaneous 

 accumulation of fat is not undesirable, this high calory diet will, as a rule, 

 be the easiest way of accumulating albumin. But here we should always 

 remember that muscular work is an important auxiliary means of fixing the 

 retained albumin in the organs of the body, and that a simultaneous high- 

 proteid diet is not superfluous or even unnecessary. (See the considerable 

 albumin accumulation in the investigations of Liithje.) 



That it is not immaterial in saving albumin whether the calory surplus is 

 brought about by fat or carbohydrates in the food was shown long ago by 

 the investigations of Voit and Buhner. Clinical researches in metabolism 

 have confirmed this. In Kayser's ^ researches albumin was lost when he 

 replaced the carbohydrates by an isodynamic amount of fat, and Tallquist ^ 

 also demonstrated that the carbohydrates were capable in a higher degree than 

 fat of protecting the albumin of the body from loss. 



To understand these differences, which apparently cannot be reconciled 

 with the laws of isodynamics, it is well to remember the experiments of Eubner, 

 according to which the different food stuffs (in equal excess) increase the 

 interchange of energy very differently because they are utilized in quite vary- 

 ing amounts, the fats undergoing combustion in metabolism, less so than the 

 carbohydrates. 



In the practical therapy of nutrition this preponderance of the carbo- 

 hydrates in comparison with the fats as albumin savers must not permit us 

 to abstain from the plentiful use of fat for the purpose of saving albumin, 

 especially in those cases in which carbohydrates are not allowed, i. e., in 

 diabetes. And since we see here that with an exclusive albumin fat diet 

 (without immoderate excess of albumin) diabetics are able to preserve their 

 albumin condition with a relatively slight administration of fat calories, we 

 might almost believe that the fats under certain circumstances may almost 

 equal the carbohydrates in their albumin-saving effect. In the very plentiful 

 use made of fat in modern dietetics we see further evidence of this. 



THE FOOD REQUIREMENT OF THE SICK 



For all physicians a fair comprehension of the total food requirement of 

 the diseased organism is the best foundation in prescribing a suitable diet. 

 Modern nutritive therapy no longer limits itself to the prohibition of this or 

 that food. It expresses positive opinions in ordering the diet, both as regards 

 the nature and the quantity of the food. 



Only in diseases which run a rapid course may the amount of food con- 

 sumed be for the time disregarded. Here real starvation may be necessary on 



1 Kayser, " Ueber die Beziehungen von Fett und Kohlehydraten zum Eiweissumsatz 

 des Menschen." Diss., Berlin, 1893. 



2 Tallquist, " Zur Frage des Einflusses von Fett und Kohlehydraten auf den Eiweiss- 

 umsatz des Menschen." Arch. f. Hygiene, Bd. xli, p. 177, 



