THE FOOD REQUIREMENT OF THE SICK 37 



In view of the criticisms which Camerer and Eubner have devoted to these 

 investigations we shall, however, withhold acceptance from the conclusions 

 which Sonden and Tigerstedt have drawn from their researches in regard to 

 the varying intensity of the processes of metabolism in the young and in the 

 aged. (See Table.) 



THE MAINTENANCE DIET AND THE PROTEID REQUIREMENT 



OF THE SICK 



Besides the complete technic and investigations which can be carried on 

 by means of complicated apparatus, we can use at the bedside a simpler method 

 to determine the total metabolism, viz. : the calculation of the tension power, 

 based upon the food which has been consumed. The demonstration in Buh- 

 ner's studies that to supply suitable energy the food of man must be adapted 

 to his condition of life permits the conclusion that if the individual, although 

 ill, maintains his body-weight, the supply of force present in his food corre- 

 sponds with his metabolism (interchange of force). 



The calculation of the energy value of food from the standard figures 

 given by Eubner is simple, and is in general use to-day. The only question 

 that arises is whether the control of the body-weight and the frequent com- 

 putation of the N-balance is sufficient to indicate all important changes in 

 the material condition of the body. 



But for the clinical pathology of metabolism this is certainly sufficient, 

 and with the proviso that this assumption is justifiable, the quantitative anal- 

 yses of metabolism in patients, now coming into common use, give us valuable 

 points for the administration of food suitable for the maintenance of the 

 organism in special diseases, either hypernutrition or hyponutrition. 



A few of these investigations have been mentioned. It would extend this 

 article too much if I were to enumerate them all; and some of them will be 

 referred to later. (See absorption investigations.) 



V. Noorden's systematic tests of the energy value of food and his methods 

 of producing a rapid increase in weight, will be described explicitly. 



In eight women who were confined to their beds weight began to increase 

 when the food reached the following values: 26, 36.5, 19, 32, 33, 36, 36, 38.5, 

 39 calories per kilogram and per day. Upon the average 32 calories per kilo- 

 gram. 



In five women who were out of bed for two to three hours during the day, 

 increase in weight began when the value of the food reached 28, 31.5, 34, 36.5, 

 36.5, 40 calories per kilogram and per day. Upon the average 34 calories. 



In four women who spent most of the day out of bed, and occasionally 

 walked about in the garden, increase in weight began when the value of food 

 reached 32, 37, 37, 41 calories. Upon the average 37 calories per kilogram. 



Although these figures demonstrate that increase of weight occasionally 

 occurs even when the calory value of the food is very slight (27 calories), never- 

 theless v. Noorden cautions us that food in which the calory value is less than 

 30 calories per kilogram should not be used. The increase in weight with 

 small calory values is usually limited to patients in whom prolonged under- 

 nutrition has led to a decided diminution of the amount of water in the body, 



