CONCLUDING REMARKS 49 



CONCLUDING REMARKS 



In the pursuit of knowledge regarding metabolism in pathological condi- 

 tions, also in the nutrition of the sick, in the last twenty years, it would 

 be unjust to ignore the importance of the dynamic point of view in the inves- 

 tigation of the processes of metabolism, which to-day dominates pathology 

 as well as physiology. 



On the other hand, however, we cannot be too careful — when relying upon 

 a law based upon the combustion value of individual food products — in con- 

 sidering the quantitative exclusively, or even to such an extent as has been 

 the custom of the average student of metabolism in the last few years. 



Primarily it is practical experience at the bedside which should dictate 

 the diet, and not theoretical knowledge of food requirement, however well 

 founded. The patient cannot be nourished with calories alone, and it would 

 certainly restrict the further progress of our knowledge of the laws of nutri- 

 tion if we should consider the caloric value of the individual foods more, and 

 the individual digestibility and tolerance, the manner of preparation, etc., of 

 foods less. 



All honor to the calory reckoning of the food — it is of inestimable value 

 in the treatment of chronic diseases — ^but we must beware of carrying it too 

 far. In practice we have a sufficiently well-founded dietetic treatment, espe- 

 cially in acute disease, without calory reckonings. 



But apart from this limitation of its value in practical dietetics, which is 

 not to be misunderstood, the purely dynamic conception of processes of metab- 

 olism has not always influenced our scientific understanding and research in 

 these problems in a fortunate way. 



Upon one of the first pages of Hoppe-Seyler's Physiologic Chemistry, 

 these words are italicized : " The process of life of the organism is, in the 

 main, a complete mystery." 



When we read, however, in modern clinical researches in metabolism, that 

 in the form of albumin, fat or carbohydrates only such and such calories are 

 to be allowed in the diet, or are to be eliminated from the diet, in order to 

 increase or to diminish the proteids or fat of the body, or definitely to influ- 

 ence the activity of the organism in this or that direction, we might almost 

 believe that the veil had long been lifted from the mystery, while in reality 

 we are as far from a solution as we were in the period in which Hoppe-Seyler 

 wrote the foregoing words. 



In the modern pathology of metabolism the view is constantly becoming 

 more prominent that the calory carriers of the introduced food are simply 

 decomposed in the daily metabolism of the body without having hecome an 

 integral constituent of the organism. This prevents us from studying the 

 great problem of life, and the investigator gets his inspiration not from the 

 hope of a speedy solution of the problem but purely in the exhilaration of 

 steady work and steady progress upon the path already trodden ; still the goal 

 itself must never be lost sight of. 



This, however, is the case if the view is accepted as final that the mystery 

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