26 ANALYSIS OF DISTURBANCES OF METABOLISM 



under certain circumstances, the regulation is quite different from that in the 

 lean person. In the latter, the greatly increased heat produced by hard 

 physical exercise may be completely removed by radiation and conduction; 

 in other words, by increasing the temperature of the skin, and this is attained 

 by increased activity of the circulation of the blood. In the obese this method 

 is unavailing, and the secretion of sweat must vicariously take the place of 

 the insufficiently active blood-current. Even in rest and in sleep, the obese 

 person, particularly in a very warm atmosphere, throws off more moisture in 

 a humid atmosphere than in a dry one. As regards the endurance of high 

 temperatures the person with great deposits of adipose tissue is easily over- 

 come, even in rest, and especially so on exertion. Besides the insensible per- 

 spiration which must be counted in heat regulation, the obese loses greatly 

 by the sensible perspiration which exudes from the skin, and there is no doubt 

 that as a result of this his metabolism (through changes in the blood com- 

 position) is very different from that of the lean individual when exposed to 

 changes of temperature. 



The numerous and practical methods given us by physiology for estimat- 

 ing the degree of oxidation in health make it obvious that pathologic condi- 

 tions should be studied and classified from the same point of view: Is the 

 intensity of the processes of combustion increased or diminished, or unaltered ? 



It is well known that Bouchard ^ has described an important group of 

 diseases (diabetes, obesity, gout) as the consequence of a "slowing of metabo- 

 lism," and lately has extended the scope of this disturbance of metabolism 

 still further so as to include in this group other pathological conditions. 



Formerly such facts as the increased excretion in the urine of incomplete 

 products of combustion (uric acid, oxalic acid), maintenance of life on a 

 lessened amount of food, the deposition of fat with a normal intake of food, 

 decrease of body temperature at rest, etc., led him to ascribe the condition 

 to a slowing of metabolism. To-day he attributes to a " slowing of metabo- 

 lism" any disease which is shown by statistics to occur frequently in asso- 

 ciation with diabetes, obesity, or gout, or which he supposes to have a genetic 

 relationship with these diseases. 



Such a division. Justified perhaps from the standpoint of clinical inves- 

 tigation, has absolutely no foundation in exact quantitative analyses of metabo- 

 lism. Where exact analyses have been carried out we find diseases grouped in 

 an entirely different manner. In quite a number of pathological conditions 

 which are to be considered here, we have exact analytic data concerning the 

 intensity of the processes of oxidation and it will be interesting to consider the 

 results from this standpoint. 



1 Bouchard, " Troubles prgalables de la nutrition in Traite de Pathologie ggngrale," 

 Tome iii, p. 179. 



