22 ANALYSIS OF DISTURBANCES OF METABOLISM 



account of the altered functions of the stomach and intestines, and we may 

 make up our minds regarding the quantity and choice of the food, quite inde- 

 pendently of the actual food requirements of the body. 



In convalescence from such maladies and in all protracted diseases, how- 

 ever, the quantity of the food is important. A proper appreciation of this 

 in the dietetic treatment of chronic diseases will give the physician his best 

 results. 



The appetite which normally regulates the quantity of nourishment in- 

 gested, so that metabolism is always exactly covered in spite of all variations 

 in regard to amount, is no measure for the amount of food required by the 

 sich. Appetite is no guide when wasting diseases increase the food require- 

 ment of the body; appetite is equally deceptive when excessive corpulence 

 makes it imperative to bring about a reduction of the body-weight. 



Only an exact knowledge of the amount of total energy metabolism, the 

 sum of the energy which the body requires and utilizes in the special case, 

 is a guide to the physician for his dietetic orders in respect to quantity. 



THE DEGREE OF OXIDATION 



Eegarding the degree of metabolism in disease, clinical researches in the 

 last few decades have given us definite figures. 



Without a knowledge of the amount of nourishment consumed, and with- 

 out a proper consideration of the energy values contained in it, mere observa- 

 tion at the bedside, and the analysis of the excretions in the urine exclusively, 

 have frequently led to entirely erroneous conclusions. French literature re- 

 garding azoturia, and the writings of Bouchard regarding the slowing of 

 metabolism, contain numerous examples of this fallacy. Increase or slowing 

 of metabolism had been frequently assumed in cases in which later control 

 experiments in metabolism proved the contrary. When the exact methods of 

 the German physiological schools (Voit, Pfiiiger, Zuntz) were employed ia 

 the analysis of the processes of metabolism in the diseased organism the for- 

 mer conclusions were reversed. In spite of this, we cannot yet claim clear 

 insight into many pathologic conditions, but we may nevertheless say that 

 many deeply rooted errors have been corrected by the methodic quantitative 

 labors of our clinics. 



Metabolism in the normal human adult, in complete rest, amounts to 

 about one calory per kilogram of body- weight and per hour; therefore with a 

 weight of 70 kilograms, in twenty-four hours it is 1,680 calories {= 24 

 calories per kilogram). Even with the ordinary exertion of daily life a 

 decided increase occurs (from about 2,450 to 3,000 calories, i. e., 35 to 42 

 calories per kilogram). Increased ingestion of food, bodily exercise (muscu- 

 lar labor) and the unavoidable giving off of heat while exercising are the 

 factors to which this increase of transference may be attributed. The amount, 

 the time limits and duration of the increase of metabolism resulting from 

 exercise in healthy persons have been for this reason closely studied. 



The hope that differences in the rate of interchange of force in the well 

 and the sick while at rest could be measured by the estimated intensity of 



