THE FOOD REQUIREMENT OF THE SICK 29 



Magnus-Levy/ by his many valuable physiological- researches in this realm, 

 was the first to attempt to estimate the factors of respiratory metabolism in 

 Graves' disease (Basedow's disease). He found the O2 intake and the CO, 

 excretion decidedly greater, even 50 per cent, greater, than the rest values of 

 healthy individuals. At the same time his results showed that the admin- 

 istration of thyreoid extract in normal persons resulted in the same increase 

 of the interchange of gases. 



These investigations also furnished the first experimental proof that there 

 are toxins in metabolism which cause increased activity in the cells of the 

 body during rest, and this discovery furnished a clue for the understanding of 

 the disturbance in metabolism observed in Graves' disease (emaciation, sweat- 

 ing, sensations of heat) as well as the clinical symptoms after thyreoid gland 

 feeding, which are in many points similar. 



A year before this practical use had been made of the effects of metabolism 

 thus elucidated, when Leichtenstern ^ determined the actual loss in weight of 

 obese persons after thyreoid gland administration, and with this inaugurated 

 a medical treatment for obesity. 



The quantitative investigations in metabolism which followed the clinical 

 advice of Leichtenstern, the loss of weight after thyreoid administration, and 

 the attempts to analyze the constituents of this loss first demonstrated that 

 there is a decided loss in proteids and water. But some of the investigators '" 

 soon observed that, even when N-equilibrium was completely maintained, 

 there was decided loss in weight which could only be explained by loss of water 

 and fat. Analysis of the respiratory metabolism showed an enormous increase 

 in the intensity of the processes of oxidation, and thus confirmed the clinical 

 observation that in the losses of weight which are observed during thyreoid 

 feeding it is particularly the body fat which is subject to increased oxidation. 



But it is certainly not on the body fat alone that the overflooding of 

 metabolism with thyreoid secretions exerts its deleterious action in severe cases 

 of Graves' disease. 



Even if we take the largest increase over " rest metabolism " which has 

 ever been observed in Graves' disease (about 50 per cent, or 1,800 calories), 

 an additional consumption of 900 calories or about 100 grams of fat in the 

 daily food would cover the loss. Yet as a matter of fact exact quantitative 

 investigations in metabolism have shown that we are not always successful in 

 maintaining the equilibrium of body- weight (Fr. Miiller),* even by a very 

 profuse administration of nourishment, and only in mild cases, when condi- 

 tions are favorable for a profuse intake of nourishment (good appetite), can 

 the proteid constituents of the body be preserved (Scholz).^ 



The etiologic relations and the clinical contrasts between Graves' disease 



1 Magnus-Levy. Berl. klin. Wochenschr., 1895, Nr. 30. 



2 Leichtenstern, " Ucber Myxodem und iiber Entfettungseuren mit Schilddriisenfiit- 

 terung." Deutsche med. Wochenschr., 1894, Nr. 50. 



^Orawitz, Munckener med. Wochenschr., 1896, Nr. 14. 

 * Fr. Miiller, Arch. f. klin. Med., vol. li, p. 36. 

 s Scholz, CentralU. f. inn. Med., 1895, Nr. 43. 



