40 ANALYSIS OF DISTURBANCES OF METABOLISM 



in the tables of v. Leyden and Klemperer (loc. cit.). That the carbohydrates 

 in themselves are superior to the fats as albumin savers (see page. 21) and 

 that they are especially valuable in the diet of fever and cancer patients as 

 compared with albumin and fat (the administration of vrhich is frequently 

 limited by an unconquerable repugnance and by difficulty in digestion), is 

 clearly shown by experience at the bedside as well as by experimental study. 

 In fever artificially produced May ^ found a limitation of the combustion of 

 albumin as a result of the profuse intake of carbohydrates. 



In spite of the pathologically increased toxogenous decomposition of albu- 

 min the laws which normally control the metabolism of albumin are still 

 active in wasting diseases. This fact should always be borne in mind, and 

 measures based upon it should be employed in the dietetic treatment of such 

 cases. Hirschfeld ^ succeeded by forced feeding in attaining an N-accumu- 

 lation in tuberculous febrile cases, v. Koorden, in his text-book, mentions 

 quite a number of patients with temperatures of over 101.3° F. in the late 

 weeks of typhoid cases running a slow course, also patients with sepsis and 

 pulmonary tuberculosis, who on a diet rich in albumin but not of particularly 

 high calory value were able, at least for two weeks, to maintain their body- 

 weight. 



Whether nitrogen-equilibrium actually existed in these cases cannot be 

 determined from the figures given. There is a great difference as regards 

 the N-balances in febrile and those in non-febrile convalescents for, with the 

 same calory supply, we can produce in afebrile cases a decided gain in albu- 

 min while in febrile cases we can scarcely maintain the nitrogen-equilibrium. 



The " intoxication necrosis " of the tissues which occurs in febrile dis- 

 eases as well as from under-nutrition, and the deleterious effects of which 

 cannot be prevented by any known means, is followed in convalescence by a 

 remarkable endeavor of the enfeebled cells to recuperate. They attempt to 

 gorge themselves with albumin, and the balance of metabolism which termi- 

 nated in a nitrogen deficit suddenly begins to show an IST-retention (Diinsch- 

 mann, v. Leyden and Klemperer, loc. cit.). 



The great rapidity with which this N-retention may occur despite a nor- 

 mal calory supply and normal proteid supply has been noted in numerous 

 studies of metabolism.^ In this connection Liithje's * latest experiments in 

 forced feeding have shown what can be done by means of abundant food dur- 

 ing convalescence. In his studies of convalescents from enteric fever, N-reten- 

 tion of from 10, 13 to even 14 grams of N per day, corresponding almost to 

 100 grams of albumin within twenty-four hours, was repeatedly observed. 



This N-addition is all the mprS remarkable because, in my opinion, we 

 must assume that the retained nitrogen is utilized for the production of living 

 protoplasm, and therefore is utilized in the total metabolism. 



1 May, " Der StoflFweehsel im Fieber." Zeitschr. f. Biologie, Bd. xxx, p. 41. 



2 Hirschfeld, Deutsch. Arch. f. klin. Med., 1882, Bd. xxx, p. 28. 



3 Albu, " Ueber den Eiweissstoflfwechsel bei chronischer Unterernahrung." Zeitschr. 

 f. klin. Med., Bd. xxxviii, p. 250; here also the other literature. 



* Lilthje, Beitrage zur " Kenntniss des Eiweissstoffwechsel." Zeitschr. f. Idin. Med., 

 Bd. xliv, p. 22. 



