THE FOOD REQUIREMENT OF THE SICK 39 



to note in his cancer patients that in malignant cachexia, even with a plenti- 

 ful calory supply (with sufficient albumin elements in the food), it was often 

 impossible to attain N-equilibrium. Gartig ^ confirmed these reports. 



Here a toxin damages the protoplasm of the cells, and the albuminous 

 ddbris of cells, decidedly beyond the requirements of the pathologic organism 

 for albumin, enters the circulation, there to suffer complete destruction. 



In fever patients, in whom the extraordinarily high urea figures obtained 

 by former investigators (Traube and Naunyn) were for a long time empha- 

 sized, we now have numerous analyses of metabolism some of which show 

 that the destruction of tissue in acute cases of fever cannot be entirely pre- 

 vented by any mode of nutrition (v. Leyden and Klemperer^). 



The same is also true of certain severe forms of anemia. Yet the increased 

 decomposition of albumin does not always occur in impoverished conditions 

 of the blood. We know this from the researches of v. Noorden, who conducted 

 exact analyses in metabolism in severe chlorosis, which prove beyond doubt 

 that such patients, with the ordinary calory supply and without particularly 

 large amounts of albumin, are able to maintain their N-equilibrium (Lip- 

 mann-WulfE'). On the other hand, there are certain clinical cases character- 

 ized by a severe course, the so-called pernicious anemias, some of which are 

 to-day explained by the presence of intestinal parasites; in these the proteid 

 metabolism is pathologically increased. Even the first clinical observers of 

 the disease (Striimpell, Eichhorst) found in these patients high urea values, 

 though of course these figures, without simultaneous observation and analysis 

 of the food, did not prove anything. Exact analyses of metabolism which 

 Eosenquist * lately carried out in patients with bothrioeephalus-anemia have 

 determined with certainty that, at any rate in this form of pernicious anemia, 

 there is an increased decomposition of albumin. These researches constitute 

 conclusive proof of the law of so-called toxogenous decomposition of albumin, 

 for they illustrate how, shortly after the expulsion of the parasites (five to six 

 days later), an accumulation of albumin, formerly impossible, was attained. 

 As the blood changes here depend upon toxic action, after the removal of 

 which normal regenerative changes take place, so also the pathologic decom- 

 position of albumin may be readily stopped by expelling the parasites. 



The indications for preventing the threatening tissue destruction in febrile 

 and cachectic patients are much more obscure. Yet this is often of para- 

 mount importance in dietotherapeutic endeavors. 



Practical experience shows that the two methods which improve the albu- 

 min balance in the healthy are also applicable here. By the administration 

 of a liberal albumin diet, the N-loss may be diminished during fever (Bauer 

 and Kiinstle) ; the same result can be obtained by giving a profuse calory 

 supply of N-free substances. For both processes excellent methods are found 



1 H. Gartig, " Untersuchungen iiber den Stoffwechsel in einem Fall von Care. OSsopli- 

 agi." Diss., Berlin, 1890. 



2 V. Leyden und G. Klemperer, " Ernahrungstherapie in acuten Fieberkrankheiten.'' 

 " Handbuch d. Ernahrungsther.," Bd. ii, p. 408. 



3 Lipmann-Wulff, " Ueber Eiweisszersetzung bei Chlorose." Diss., Berlin, 1891. 

 * Rosenquist, Berl, klin. Wochenschr., 1901, p. 666. 



