THE FOOD REQUIREMENT OF THE SICK 31 



ciently explained by the increase in proteid decomposition which forms part 

 of every febrile process and, as it appears, bears a much more intimate rela- 

 tion to febrile processes than the increase in oxidation (Traube, Naunyn ^). 



The investigations which are constantly multiplying make it obvious that 

 there is no constant and direct relation between the height of the temperature 

 and the degree of the increase of oxidation. Febrile conditions occasionally 

 show a conspicuously low consumption of oxygen, and afebrile cases con- 

 spicuously high. 



The indications to be derived from this, in regard to the regulation of 

 nutrition in fever patients, are obvious. It is not the absolute height of the 

 fever which endangers the metabolism of the body, and for this reason it 

 should not be our only care to study minutely the diet of our patients. On 

 the contrary, it is the toxins produced by infection which prove injurious 

 to the nutritive condition of the body, and in all cases in which the physician 

 recognizes these deleterious consequences, he must arrange the dietary accord- 

 ingly. Eemembering this he will not disregard the dietetic indications of 

 many afebrile infectious diseases (some forms of pulmonary tuberculosis). 



In contrast with fever, in which the increased combustion causes much 

 less difficulty than the toxogenous proteid decomposition (see below) is the 

 nutrition of convalescents. Here these difficulties are usually slight. 

 Analysis of the diet, under which debilitated patients after long-continued 

 under-nutrition are able to increase in weight, has frequently shown aston- 

 ishingly low energy values. Fr. Miiller ^ in a case of stenosis of the esophagus 

 after intoxication from caustic potash studied a fearfully emaciated patient, 

 who gained 3.5 kilograms in three weeks, under a diet of only 24.7 to 30 

 calories per kilogram. Among G. Klemperer's ^ patients there were some 

 who throve very well on a diet containing only 13.5 to 18 calories per kilo- 

 gram. A patient of Nebelthau's * who was greatly emaciated in consequence 

 of stubborn vomiting, accumulated very considerable amounts of albumin 

 despite a quite insufficient proteid and calory administration after she had 

 remained for four days without any food. 



Without doubt the processes of oxidation are here decreased to a certain 

 degree. The metabolism is diminished to the minimum which is absolutely 

 necessary to maintain life. Correspondingly, the formation of heat is slight 

 (tendency to chilliness), and the power of bodily activity is limited. 



There is no objection to our assuming that this diminution of metabolism 

 in chronic under-nutrition is a true slowing of metabolism. This makes it 

 possible to maintain life even under very unfavorable external conditions, 

 and is apparently produced gradually by adaptation and habit. 



Sudden withdrawal of nourishment does not diminish the total metabolism 



1 Naunyn, Berliner klin. Wochenschr., 1869, Nr. 4. 



2 Fried. Miiller, " StoflFwechseluntersuchungen von Krebskranken." Zeitschr. f. klin. 

 Med., vol. xvi, p. 496. 



3 G. Klemperer, " Ueber Stoffweohsel und Ernahrung in Krankheiten." Zeitschr. f. 

 klin. Med., vol. xvi, p. 550. 



*Nelelth(m, "Ein Beitrag zur Kenntniss der Acgtonurie." Centralbl. f. inn. Med., 

 1897, p. 977. 



