METABOLISM IN FEVER AND CERTAIN INFECTIONS 97 



clinics at some time during the course of the year. The fever itself is 

 fairly regular in its course and offers a period of rising temperature, a 

 period of level temperature, sometimes two weeks long and a period of fall- 

 ing temperature with wide remissions. Patients with this disease lend 

 themselves well to experimental procedures. They are apathetic and are 

 not worried by the display of apparatus. Their circulatory systems are 

 dependable and cause the investigator little anxiety. 



FEVER 



TTNVALF r SCFN( 



OL CONT.TEMP. STEEP CURVE PERIOD 



I ST WEEK 



2 o WEEK 



3o WEEK 



4-mWEEK 



RELAPSE 



IS = 



jilBI 



Fig. 1. The total metabolism of patients with typhoid fever expressed in terms 

 of calories per square meter (Meeh's formula) per hour. Lines are drawn to show 

 the average normal and the point 50 per cent above the average normal. The upper 

 part of the figure gives the results obtained by Coleman and Du Bois on patients on 

 the high calory diet, the lower part shows the cases on low diets studied 14 or more 

 hours after the last meal by Kraus, Svenson, Grafe and Roily. 



Although typhoid fever may be mild in its course the majority of 

 cases are severe enough to cause great prostration, and these severe cases 

 are so greatly influenced by treatment that they may be divided into 

 two groups which differ from each other as much as if they were two 

 different diseases. In the first group we have the patients who are kept 

 on the old-fashioned semi-starvation diet of broths, lemonades with egg 

 albumin and milk in limited amounts. These show the classical picture 

 of the so-called "typhoid state" with emaciation, delirium, tremors, etc. 

 In the second group are the patients who are given liberal diets of more 

 than two thousand calories a day. These show but slight emaciation and 



