ELIMINATION OF METABOLIC END-PRODUCTS 619 



quirement of a bed- fast human being. Schaffer 25 was able 

 to maintain a case of typhoid fever on a diet low in protein, 

 but rich in carbohydrate (consisting of milk, milk-sugar, 

 cream, eggs and arrowroot) at approximate nitrogen bal- 

 ance. Similar attempts have recently been carried out at 

 the Heidelberg medical clinic by Graf e, 26 who obtained prac- 

 tical nitrogen balance in febrile human subjects by an ex- 

 hibition of food of fifty calories per kilogram ; as the result 

 of which he regards the assumption of a toxogenic protein 

 decomposition as superfluous. There is thus no doubt of 

 the fact that destruction of protein in fever can be materially 

 lessened by administration of judiciously selected food. 



We may perhaps approach most nearly to the truth by 

 holding that the destruction of protein in fever is caused by 

 a combination of influences from the above-mentioned fac- 

 tors, of which now one, now another, may come to be domi- 

 nant according to circumstances. 



Elimination of Nitrogenous Metabolic End-Pro ducts. 

 In view of the extensive destruction of protein which may 

 take place in fever it is not at all remarkable that the elim- 

 ination of nitrogenous end-products of metabolism may 

 present certain abnormalities. 27 According to statements 

 already made in reference to " endogenous " cellular me- 

 tabolism it can be readily appreciated how in fever some- 

 times a decided increase in the output of uric acid and of 

 creatinin (or the total creatin + creatinin) 28 has come to 

 be observed in connection with the increased protein decom- 

 position, and how at times certain residua of protein me- 

 tabolism (or products of incomplete protein decomposition) 

 may be met in increased quantity in the urine. The fre- 



35 P. A. Schaffer (Cornell Med. College, New York), Jour, of Amer. Med. 

 Assoc., 51, 974, 1908. 



38 E. Grafe (Med. Clinic, Heidelberg), Vortr. auf d. Karlsruher Natur- 

 forscher Vers., 1911, cited in Gentralbl. f. d. Ges. Biol., IS, No. 932. 



*Cf. Literature, P. F. Richter, 1. c., pp. 119-123. 



K Cf. also V. C. Myers and G. O. Volovic, Amer. Jour, of Physiol., 29 t 

 Proc. Amer. Physiol. Soc., XVIII, 1912. 



