38 ANALYSIS OF DISTURBANCES OF METABOLISM 



so that the increase in weight observed may be referred more to a satiation 

 of the demand of the tissues for water than to an actual gain in substance.' 



Yet it cannot be doubted, in view of these experiments, that, in emaciated 

 individuals, administration of food of very slight calory value may compen- 

 sate completely for the food requirement and the interchange of force, and 

 may even permit an increase in weight. For if, in spite of a slight calory 

 administration, N-equilibrium has been maintained for a long time and albu- 

 min actually accumulated, there cannot be a calory deficit for any length 

 of time. Later investigations in metabolism show that the IST-balance is to a 

 great extent independent of the calory supply. The stimulation of albumin 

 accumulation which results from muscular exertion as well as from growth 

 makes possible an IST-retention even with an insufficient calory supply and an 

 actual loss in weight ( Caspar i ^). 



But there are many observations showing that after prolonged under- 

 nutrition, such as occurs in disease, the body may, up to a certain point, adapt 

 itself to a smaller amount of food. It limits itself to the functions absolutely 

 necessary to maintain life, and under these conditions the slightest increase 

 in food soon brings about an increase in weight as well as a retardation of 

 the pathological processes, under the action of which the body has become so 

 reduced. The lessening of body-weight, upon whose maintenance, according 

 to Pfliiger, the energy of metabolism is dependent, becomes here the direct 

 cause of a diminished rate of metabolism. 



The emaciation which is the invariable consequence of many diseases finds 

 its chief expression in the decrease of body-weight, so that frequent weighings 

 of the body in chronic diseases are, as Gerhardt says, almost as valuable as 

 the temperature record in acute diseases. The variations may, however, be 

 due to various causes. 



When patients suffering from gastric disease are emaciated this is often 

 due wholly to the poverty of the calory value of their food, as was first emphat- 

 ically stated and clearly proven by v. Noorden. The fear of pain, or a false 

 estimation of the nutritive value of individual foods, may have aided in bring- 

 ing this about. If food of normal calory value be given, the loss in weight 

 ceases. 



Other patients (Graves' disease), as we have noted, lose weight, in spite 

 of a calory intake sufficient for the healthy, because the intensity of the 

 process of combustion is decidedly increased. If the capacity for taking food 

 is great, as in many afebrile tubercular patients and in many cases of Base- 

 dow's disease, the calory contents of their food need only be increased beyond 

 the usual needs of the healthy, and they will not only attain their N-equi- 

 librium, but will very soon begin to accumulate fat. 



This, however, does not succeed in all cases. Fr. Mliller ^ was the first 



1 V. Noorden, " Stoffverbraueh und Nahrungsbedarf in Krankheiten.'' Arbeiten aus 

 dem siiidt. Krankenhaus zu Frankfurt a. M., 1896, p. 3. 



2 Caspari, " Ueber Eiweissumsatz und Ansatz bei der Muskelarbeit." Pfluger's 

 Arch., Bd. Ixxxiii, p. 509. 



3 Fr. Miiller, " Stoflwechsel bei Krebskranken.'' Zeitschr. f. klin. Med., Bd. xvi, 

 p. 496. 



