98 



EUGENE F. DU BOIS 



suffer so little from nervous symptoms that they read the newspaper every 

 day. This is the real picture of typhoid fever, the other is a combination 

 of typhoid and inanition. 



The Total Metabolism in Typhoid Fever. The literature dealing with 

 the respiratory metabolism in typhoid fever is voluminous. Much of it is 

 bedevilled by poor technic and it will be a long time before science can 

 exorcise the numerous wild theories which were manufactured to explain 

 false data. Fortunately at the present time we have consistent reports 

 from many clinics and the facts are well established. 



The total heat production and the destruction of protein during the 

 febrile period are increased but otherwise the metabolism is much the 

 same as in normal subjects. There is no evidence of any profound dis- 

 turbance in the combustion of fats or carbohydrates. Even the increase in 

 total metabolism is comparatively slight, not approaching the levels found 

 in severe hyperthyroidism or moderate muscular exercise. The data ob- 

 tained by Kraus(a), Svenson, Grafe, Roily, and Coleman and Du Bois(a) 

 (1914) have been summarized in Figure 1 and Table 1. All of these in- 

 vestigators used the method of indirect calorimetry, determining the con- 

 sumption of oxygen and production of carbon dioxid. Grafe, with a res- 

 piration chamber, used experimental periods several hours long. All the 

 others used periods of 10 to 30 minutes. The patients lay quietly in bed, 

 attached by masks, nose-pieces or mouth-pieces to some type of apparatus 

 which made it possible to analyze the expired air. Kraus, Grafe and 

 Roily studied patients on low diets which did not cover the caloric require- 

 ments and made their observations in the morning 12 to 14 hours after 

 the last meal. Svenson used similar subjects during convalescence. Cole- 

 man and Du Bois, in their first series, gave their subjects 35 to 102 

 calories per kilogram per diem and measured the metabolism during the 



TABLE 1. HEAT PRODUCTION DURING THE COURSE OF TYPHOID FEVER 



