34 ANALYSIS OF DISTURBANCES OF METABOLISM 



It is remarkable that in certain forms of obesity no diminution of the 

 physiologic processes of combustion can be determined. Clinicians have 

 noted two classes of cases, (a) those in which overeating and deficiency of 

 muscular labor were the obvious causes of the accumulation of fat, and (&) 

 those in which even a normal amount of food resulted in accumulation of 

 fat, and even with a decided diminution of nourishment it was impossible to 

 bring about a reduction in weight. 



V. Noorden ^ reports the case of a man weighing 103 kilograms who — in 

 spite of the fact that his food during three months did not exceed 1,730 

 calories per day, and that as an inspector of a country district he had every 

 day plenty of exercise — ^lost only a kilogram of weight in three months. In 

 a lady weighing 86 kilograms he failed to produce the slightest diminution 

 in weight in the course of six weeks, though he reduced the food to 900 to 

 1,000 calories. In a woman weighing 145 kilograms, Stadelmann^ reports 

 that with a diet containing but 1,500 calories per day she not only throve but 

 even gained one kilogram per week in weight. Only when nutrition was 

 reduced to 1,000 calories did she begin to lose weight, while on 1,300 calories 

 she gained in weight for a time. (Compare the criticisms of these reports 

 in Eubner.)^ 



In the light of these observations the question constantly arises, whether 

 the tissue elements of obese persons do not require a slighter amount of mate- 

 rial to perform their normal functions, and whether the very ready accumula- 

 tion of fat is not due to the fact that the organs ftmction more economically 

 than under normal conditions, v. Noorden was the first to study this ques- 

 tion by exact experimental investigation, and in his excellent text-book, The 

 Pathology of Metabolism, which stimulated so many later researches in metab- 

 olism, he worked out in two cases of obesity the first figures representing the 

 consumption of oxygen and the excretion of carbonic acid. (See Table.) 



Eesearches by Magnus-Levy followed these (Table). All the "mimite- 

 kilo-values " taken with an empty stomach are low, in fact near the lowest 

 limit of the normal standard figures. " But they are not so low that a dimin- 

 ished oxidation energy of the cells must be assumed, especially if we consider 

 that the values per kilogram as calculated in the obese become lower the more 

 fat the body accumulates. But in metabolism during quiet respiration this 

 factor is not operative. In studies regarding the intensity of the process of 

 combustion fat cannot be looked upon as of the same value as flesh and gland 

 substance" (Magnus-Levy). Thus when it appeared that analysis of the 

 respiratory metabolism (according to the Zuntz-Geppert method) would yield 

 no support for the belief that there is a diminution of the processes of com- 

 bustion in the obese, new researches by Jaquet* suggested the method by 

 which in the corpulent an economy of the food material introduced produces 

 the gradual deposition of fat. 



i V. Noorden, " Die Fettsvicht," in Nothnagel's Handbuch, p. 31. 



2 Stadelmann, Berliner hlin. Wochenschr., 1901, Nr. 25. 



3 Rubner, Beitrage zur " Ernahrung im Kindesalter," Berlin, 1902, p. 31. 



* Jaquet und Svenson, " Zur Kenntniss des Stoflfwechsels fettsiichtiger Personen." 

 Zeitschr. f. klin. Med., Bd. xli, p. 375. 



