With a third dog the food was reduced to 50 per cent of normal, the reduction being made at the rate of 1 per cent of the food quantity per day. After the reduction reached 80, 70, 60, and 50 per cent, a 3-day study of the gaseous metabolism was made at each of these points. The whole experiment lasted 87 days. The body-weight at the end of the low feeding was 13 per cent below the initial weight; the gaseous metabolism per kilogram decreased with oxygen to 94.6 per cent and with carbon dioxide to 86 per cent of the initial quantities.

Pashutin points out, with a conservatism which could well be followed by many modern writers, that his conclusions are based upon only two complete experiments in which the metabolism during realimentation was studied, and therefore he ascribes no great value to them. They are, however, at variance with those of Albitsky, who noted an increment in oxidation2 during the realimentation periods following starvation, while in Pashutin's experiments the chronic undernutrition resulted in a distinct lowering of metabolism per kilogram of body-weight. Even when the maintenance diet was exceeded, the gaseous metabolism did not reach normal, thus indicating a distinct lowering in the plane of metabolic activity.

Svenson, 1901

Svenson,3 interpreting many observations in the earlier literature as indicating lowered energy requirements with chronic undernutrition, attacked the problem from the standpoint of changes in metabolism during convalescence from typhoid fever or pneumonia. He sought to discover if, during convalescence, there was an attempt made by the organism to economize by reducing oxidation, as he considers is done in chronic undernutrition. Employing the Zuntz-Geppert apparatus, Svenson found that with typhoid patients in the first period of convalescence and in the niichtern condition, there were for a short time subnormal values for carbon-dioxide production and oxygen consumption, but the values soon increased until they gradually became abnormally high and subsequently fell again to normal values. He concludes that the lowering of the oxidation processes in the first stages of convalescence is not a sign of a definite adjustment of the organism to a lower level, but rather is incidental to the exhaustion of the organism. After long illness the functions of all the organs suffer more or less and the sensitivity of the nervous system is decidedly lowered; but when the subject's organism and the central nervous system have recovered to some degree, exhaustion disappears and gives place to an increase in metabolism. On the whole, his evidence can be interpreted as indicating low metabolism with chronic undernutrition and high metabolism with excess food.

1 These conditions seem inexplicable except on the ground that the initial equilibrium weight of 6,221 grams was in reality overweight, and accompanied by excess food intake. 2This, we believe, is due in large part to the larger food intake (see page 16). 3Svenson, Zeitschr. f. klin. Med., 1901, 43, p. 86.

F. Muller, 1903

Friedrich Muller1 admits that with long-continued undernutrition due to disease or lack of food, a lower body-weight can be maintained with a much smaller intake of food and lower oxidation processes, but nevertheless considers that such decrease of oxidation is small and the cases are exceptional.

Richter, 1904

The small amount of evidence regarding gaseous metabolism obtained in the study of Richter2 on a patient with esophagus stricture does not lead to clear deductions as to metabolism during excess feeding following emaciation. Although there was a large increase in body-weight and storage of nitrogen, the average values for the respiratory exchange of 4.8 c.c. of oxygen and 3.76 c.c. of carbon dioxide per kilogram per minute, while representing perhaps the higher border of normal values, cannot of themselves be taken as clearly indicating an excess metabolism. The gaseous metabolism measured 3 hours after the ingestion of food showed a normal stimulation from food.

Magnus-Levy, 1906

In his study of the influence of disease on metabolism, Magnus-Levy3 cites a striking illustration of chronic undernutrition and gives a lengthy series of respiration experiments with this subject at different stages of body-weight. The height was 160 cm. In the first period, when the body-weight was 36.2 kg., the temperature was subnormal, and the oxygen consumption per kilogram per minute was 3.33 c.c. When the body-weight had risen to 38 kg. the oxygen consumption had risen to 4.1 c.c. At 52.2 kg., when the subject was essentially under normal conditions of nutrition, the oxygen consumption was 4.11 c.c. In discussing this most interesting case, Magnus-Levy refers to Klemperer's research in 18894 as the first instance in which an adjustment of the metabolism to needs was noted. He points out that this is really the expression of a popular conception of the laity, which is also held by many physicians, i. e., that when the food is diminished there is diminished oxygen consumption, and with excess food there is excess oxygen consumption.

1 F. M Oiler, v. Leyden's Handb. d. Ernahrangstherapie, Leipsic, 1903, 1st ed., 1, pp. 195 and 196.

2 Richter, Berl. klin. Wochenschr., 1904, p. 1271.

3 Magnus-Levy. Zeitachr. f. klin. Med., 1906, 60, p. 177. 4 Klempere-. Zeitschr. f. klin. Med., 1889, 16, p. 550.

Magnus-Levy finds it impossible to explain the lowered metabolism of his subject on the basis of the body-surface law. We must dissent with him, however, when he states (in italics) that a lowering of the body-weight from 55 to 36 kg. produces an insignificant alteration of the body-surface. According to the height-weight chart of Du Bois, a subject having a height of 160 cm. has a body-surface of 1.31 square meters with a body-weight of 36 kg., but with a body-weight of 55 kg. the body-surface is increased to 1.56 square meters, a difference of approximately 20 per cent. Magnus-Levy is further convinced that in this case there was certainly an adjustment of the metabolism to the food consumption, pointing out that this adjustment continued at the low level only so long as the food intake was very low, and that with the large diet the metabolism immediately tended to follow the higher plane of nutrition. This is one of the clearest cases on record of the adjustment of metabolism to needs. It is somewhat surprising that so little attention has been paid to it in current literature.