THE FOOD REQUIREMENT OF THE SICK 33 



calories per kilogram to maiatain the patient for weeks in an active con- 

 dition.^ 



On the contrary, observation proves that metabolism in the diabetic may 

 occasionally be abnormally slow, and the experience accumulated by many 

 careful investigations of the nutrition of diabetics demonstrates that, in many 

 cases, it is in fact slower than the metabolism of a healthy person. I say in 

 many cases, for this is by no means true of all. A pathologic diminution of the 

 nutritive requirement is by no means the rule in diabetes. If, however, we 

 give for a long time a diet which is apparently superfluous but, in reality, 

 quite insufficient — ^because improper — under the influence of this chronic 

 under-nutrition the same diminution in metabolism may occur that also 

 occurs in other persons who are under-nourished (see above). Hence it 

 becomes possible to support life on less food than is necessary for healthy 

 people and to increase the diabetic's weight with a diet which is only just 

 sufficient for the needs of a normal person. 



Correspondingly, the rest values for Oj consumption and COj excretion 

 that have been determined in diabetes neither exceed nor fall below the limits 

 which we have come to recognize in the normal individual (Voit and Petten- 

 kofer, Leo,^ Weintraud and Laves," Stiive*). 



The same is proven by the investigations of Magnus-Levy in gout, which 

 Bouchard, as is well known, includes with diabetes among diseases character- 

 ized by decreased metabolism. 



In the various forms of anemia (chlorosis, secondary and pernicious 

 anemia) we might expect diminution of 0^ intake, in view of the more or 

 less marked diminution of the oxygen carriers in the blood, especially if we 

 remember the fatty degeneration of organs, which is frequently observed in 

 anemia. 



Experimental investigation, however, has decided against this view. In- 

 deed the values determined for 0^ intake and COj output have been shown 

 to be near the upper physiological limits. In those cases of pernicious anemia 

 which are characterized by increased proteid decomposition, this limit has 

 even been several times exceeded (Meyer,^ Magnus-Levy)." A diminution of 

 metabolism due to impoverished blood cannot therefore he assumed (Kraus,'' 

 Thiele and Nehring) .* 



^Weintraud, " Untersuehungen liber den Stoffweohsel im Diabetes melitus.'' Bibl. 

 med., Cassel, 1893. 



2 Leo, " Ueber den respiratorischen Stoffwechsel und Diabetes." Zeitsclir. f. hlin. 

 Med., vol. xix. 



3 Weintraud und Laves, " Ueber den respiratorischen Stofifwechsel im Diabetes." 

 Zeitschr. f. phys. Chemie, vol. xix. 



< Stiive, Arbeiten aus dem stadt. Krankenliaus Frankfurt a. M., 1896, p. 49. 

 6 R. Meyer, " Ueber O, Verbrauch und CO, Ausscheidung bei Anamien." Dissert., 

 Bonn, 1892. 



Magnus-Levy, Berliner hlin. Wonhenschr., 1895, p. 351. 



1 Eraus, " Ueber den Einfluss von Krankheiten, besonders von anamischen Zustfin- 

 den, auf den respiratorischen Gasweehsel." Zeitschr. f. klin. Med., vol. xxii, p. 449. 



8 Thiele und Nehring, Zeitschr. f. klin. Med., vol. xxx. 

 4 



