32 ANALYSIS OF DISTURBANCES OF METABOLISM 



to anything like the same degree. In the estimations which Zuntz and Leh- 

 mann ^ carried out in the professional faster Cetti, the " rest-values " for 

 O2 consumption and CO2 excretion during the days of starvation (on the 

 average 4.78 and 3.34 c.c.) were but little lower than during the days pre- 

 ceding the fast (5.35 c.c. Oj, and 3.90 c.c. CO2). In investigations in the 

 case of the faster Breithaupt, the average values prior to the fast and after 

 it had begun were almost exactly the same. 



Whether the ease with which patients convalescent from acute febrile 

 disease compensate for their loss in weight depends upon the same capacity to 

 economize in metabolism which enables patients in a state of chronic under- 

 nutrition to gain weight even on a diet of low calory value is a mooted ques- 

 tion. Svenson " has recently thrown light upon this question by investiga- 

 tions of metabolism in convalescence from pneumonia and from enteric fever. 



His figures (see Table on page 27) do not show a tendency to economy 

 in the processes of combustion. On the contrary, in the first afebrile days 

 after a severe enteric fever, he found a slight diminution of the respiratory 

 values; true convalescence with increase in weight was being characterized by 

 high values, and metabolism was therefore increased. Hence the increase in 

 weight cannot be explained by assuming a diminution of consumption. On 

 the contrary, the balance is positive because the intake of nourishment with 

 the usual increased appetite of convalescence is decidedly greater than the 

 energy value of the average food of maintenance (60 to 90 calories per kilo- 

 gram). 



The " rest- value " for metabolism in convalescence then is in any case 

 increased and this is particularly true of the metabolism after work, as 

 was shown by Svenson's further researches. The convalescent is able to 

 utilize in muscular work only a small portion of the energy set free by the 

 processes of combustion, and therefore has a higher COj consumption per 

 kilogram meter than the healthy man. There is no economy of metabolism 

 here. 



Diabetes mellitus was for a long time looked upon as a disease in which 

 metabolism was increased. The enormous ingestion of food which, because 

 unsuitable, is often insufficient (in spite of its great energy value) to satisfy 

 the appetite which accompanies diabetes mellitus, and to maintain nutrition, 

 naturally led to this view, at a period when a deeper insight into the econ- 

 omy of metabolism of the diabetic was not yet possible. 



The quantitative analyses of metabolism which, because of therapeutic ex- 

 periments in diet, were carried out especially often in diabetics, soon showed, , 

 however, that with suitable food, the usual calory intake was sufficient to 

 maintain the equilibrium of metabolism even in severe diabetes. 



The diabetic perversion of metabolism cannot be due to an increased inter- 

 change of products since it is possible with a diet which contains only 25 



1 Zuntu und Lehmann. Virchow's Arch., vol. cxxxi; Suppl.-Heft, pp. 50 und 91. 

 'Svenson, " Stoffwechsclversuche an Reconvalescenten." Zeitschr. f. Mm. Med., 

 vol. xliii, p. 86. 



