DU BOIS: BASAL ENERGY REQUIREMENT OF MAN 355 



liberal feeding by means of the small Benedict apparatus and of 

 the Sage calorimeter. Curiously enough the taking of food does 

 not stimulate the heat production nearly so much in typhoid 

 fever as in health, and patients on the high calory diet have no 

 greater caloric production than those on the starvation diet. 

 This shows how groundless was the old dread of fanning the fever 

 by giving food. It seems to be well established that there is a 

 toxic destruction of protein in typhoid fever. Even if we give 

 the patient plenty of protein and enough calories in food to meet 

 his caloric output, he will show a steady negative nitrogen bal- 

 ance. This phenomenon indicates that protein is broken down 

 faster than it can be reconstructed. If we wish to maintain a 

 typhoid patient in nitrogen equilibrium we must give him 4000 

 or 5000 calories a day, whereas his calculated output seldoms ex- 

 ceeds 3000 or 3500 calories. Patients do very well on these 

 large diets if they be carefully administered; and at the end of 

 the fever they are well nourished, instead of starved. The 

 proper food in large amounts does not increase the intestinal 

 symptoms. 



The disease which has the greatest effect on metabolism is exop- 

 thalmic goiter, sometimes called Graves' disease. This is due 

 to an overactivity of the thyroid gland, situated in the neck. 

 Patients who suffer from this hyperthyroidism usually show 

 some swelling of the gland, protrusion of the eyes, nervousness, 

 large appetite, and warm, moist skin. In severe cases of the 

 disease the resting metabolism may be increased 75 to 100 per 

 cent above the normal level. This explains the great demand 

 for food and the marked loss in weight if the diet be not liberal. 

 It also explains the warmth of the skin, since each square meter 

 of surface has to eliminate 75 to 100 per cent more heat than 

 normal. There is also a disease called myxoedema in which the 

 secretion of the thyroid gland is diminished. Patients with 

 myxoedema are lethargic and have small appetities and cool dry 

 skin. Their heat, production is much below the normal, but if 

 extract of thyroid gland be given them the normal level is at- 

 tained once more and their symptoms disappear. 



