During prolonged fasting the nitrogen out put sinks much below the figures of the earlier days. Thus a woman twenty-four years old averaged 4.15 gm. from the thirteenth to the twenty-fifth day of fasting.1 A girl nineteen years old whose esophagus had been occluded by drinking sulphuric acid excreted 2.8 grams of nitrogen on the sixteenth day of fasting.2 An invalid of Tuczec's3 averaged 4.25 grams of nitrogen between the fifteenth and twenty-first days. Under Luciani's observation Succi excreted 4.08 grams on the twenty-ninth day, and under E. and O. Freund his nitrogen excretion was 2.82 grams on the twenty-first day. The latter authors say that after this there was a sudden rise in the amount of nitrogen and chlorin in the urine, suggesting the so-called premortal rise, which caused them to stop the experiment. About 3 grams of nitrogen in the urine or a daily destruction of 18.75 grams of protein would seem to be the lowest extreme of protein metabolism in the emaciated organism after a prolonged fast. The analyses by E. and O. Freund of Succi's urine during a fast of twenty-one days was the first complete record of the sort. The daily nitrogen excretion is given in grams below:

Daily Nitrogen Excretion Of Succi In Starvation

1 Seegen: "Wiener Acad. Sitz. Ber.," Bd. xxxiii, 2 Abth.

2 Schultzen: "Archiv fur Anatomie und Physiologie," 1863, p. 31.

3 Tuczec: "Arch, fur Psychiatrie," 1884, xv, 784.

The nitrogen and total sulphur ran together in the urine in the proportion of 17.3 N : i S. Munk found the ratio N/S to be 14.7 in Breithaupt and 15.1 in Cetti, and Benedict (see p. 89) found 16.27 during the fifth, sixth, and seventh days of starvation. A similar relation between N and S is found in muscle. The sulphur is believed to be derived exclusively from the breaking down of protein.

The nitrogen and total phosphoric acid (P205) in the urine are not found in the same ratio as that in which they exist in meat (7.6 :1), but there is a greater phosphoric acid excretion. This is also true of the calcium excretion. This greater excretion is due to the metabolism of the bones (Munk). E. and O. Freund found that the N/P2O5 fell from 5.7 on the first day of Succi's starvation to between 4.2 and 4.4 during the subsequent periods. Munk found this value to be 4.4 in Cetti during ten days and 5.1 in Breithaupt during six days (consult table on p. 96).

Albumin is of frequent occurrence in the starvation urine of man and animals.

Urinary Analysis Of Victor Beaute On The First, Third, Twelfth, And Fourteenth Days Of Fasting

Weight In Grams.

A modern chronicle of the urinary excretion during fasting is presented in an experiment by Cathcart1 on a professional faster, thirty.one years old, a part of which is reproduced on p. 92.

In this experiment the ammonia excretion rose to meet an accompanying acidosis. The creatinin excretion gradually fell, whereas the creatin excretion (see p. 211) remained quite constant. The ratio between the nitrogen and sulphur elimination averaged 15 N : 1 S, or similar to the relation found in muscle, which is 14 N : 1 S. The relatively large potassium excretion and the small sodium excretion indicated respectively the destruction of body tissues which are all rich in potassium salts and the conservation of the body's sodium chlorid supply.

A communication by Brugsch2 shows that the quantities of β.oxybutyric acid and acetone in the urine become very great in extreme hunger. The experiment was also on Succi, between the twenty.third and the thirtieth days of starvation, and showed the following remarkable values:

Acetonuria In Starvation (Succi)

The excretion of urea nitrogen ran between 54 and 70 per cent., and the ammonia nitrogen between 15.4 and 35.3 per cent, of the total nitrogen in the urine. The high ammonia neutralized the very considerable acidosis.

1 Cathcart: "Biochemische Zeitschrift," 1907, vi, 109.

2 Brugsch: "Zeitschrift fur ex. Pathologie und Therapie," 1905, i, 419.

Grafe1 reports the excretion of 16.25 and 15.41 grams of urinary acetone bodies during the sixteenth and eighteenth days of fasting in a stuporous patient suffering from katatonic rigidity and lying in deep sleep on these days.

Folin and Denis2 have described results concerning the development of acidosis in two obese women, patients of Dr. J. H. Means.3 Mrs. M., weighing 108 kilograms, whose height was 149.7 cm. (4 ft. 1 in), underwent 3 different periods of fasting, with the following results:

Acidosis In Obesity

Headache and nausea were present on these fourth and fifth days of fasting, symptoms which disappeared as if by magic after the patient took one piece of toast and a cup of tea. The authors state "If the preceding subject was fat, our next one, Mrs. B., was a veritable pork barrel." Mrs. B. weighed 178 kilograms and measured 163.5 cm. (5 ft., 4½ in.) in height. She did not show the same intensity of acidosis manifested by the other patient, the largest quantity of β-oxybutyric acid eliminated reaching only 7.2 grams on the seventh day of a third fasting period. From these results it was concluded that obesity itself was not a predisposing cause of acidosis. In general, it was observed that the protein metabolism was low in these persons in whom ample fat was present (see p. 100), that repeating the fast lowered the protein metabolism (see Hawk, p. 104), and also that repeated fastings habituated the organism to the complete oxidation of fats as evidenced by a decrease in the amount of β-oxybutyrie acid eliminated on corresponding days of the several fasts. In this connection the observation of Abderhalden and Lampe,1 that fasting progressively increases the power of dog's blood to split tributyrin, is of significance in showing adaptative power by the organism. Folin and Denis conclude that the method of repeated fasting applied to the obese is safe, harmless, and effective, provided the intensity of the acidosis be carefully followed.

1 Grafe: "Zeitschrift fur physiologische Chemie," 1910, lxv, 21.

2 Folin and Denis: "Journal of Biological Chemistry," 1915, xxi, 183.

3 Means: "Journal of Medical Research," 1915, xxxii, 121.

In a way the results here mentioned are all summarized in the extended work of Benedict2 upon a subject L., who fasted for thirty-one days. Benedict found no evidence pf any disturbance of the higher mental function of the subject. He found a lowered power of endurance during the fast, but, according to tests made a year later, could discover no lasting evil effect of the fast either upon muscular strength or mental activity. It is recorded that no faces were passed during the entire fast.

The chart (page 96) illustrates the principal data and a table (page 97) is also given which shows the most important determinations made on the first, eleventh, twenty-first, and thirty-first days of fasting.