METABOLISM IN FEVER AND CERTAIN INFECTIONS 99 



afternoon a few hours subsequent to the last meal. In their second series 

 they gave similar diets but determined the metabolism in the morning, 12 

 to 14 hours after the last meal. These patients were observed for three- 

 hour periods in the respiration calorimeter of the Russell Sage Institute 

 of Pathology in Bellevue Hospital. At the time this work was published 

 the results were compared with a normal standard of 34.7 calories per 

 square meter per hour according to Meeh's surface area formula. Al- 

 though there are certain inaccuracies in this formula it is the best avail- 

 able for this typhoid series and probably does not introduce an error as 

 great as five per cent for the adults. In recent years, however, we have 

 realized that the metabolism is high during adolescence, and this makes 

 it necessary to recalculate their results. In Table 1 only the adult cases 

 are used for the averages. If we compare the averages for the three boys 

 of 12 to 18 years of age with the proper standards we obtain the following 

 results: Ascending temperature period +9 per cent; continued tempera- 

 ture +2 per cent; early steep curve +11 per cent; late steep curve 

 +3 per cent; convalescence first week 23 per cent, second week IT 

 per cent. 



The analysis of these figures for adults and children brings out many 

 points of interest. It is somewhat surprising to find that the average 

 increase during the periods when typhoid patients show great toxemia is 

 only 23 to 44 per cent. In typhoid fever the young subjects produce 

 about the same number of calories per unit of surface area as the adults 

 with the disease of the same severity. Just why the metabolism of the 

 boys should not be higher than that of adults is not easy to understand. 

 Allen and Du Bois have called attention to the fact that the diabetic 

 children reported by Benedict and Joslin showed low metabolism and have 

 suggested that the normal stimulus of the growing organism is checked 

 by diabetes. This may be true of fever but it is quite possible that the 

 stimulus of growth takes the place of the stimulus of fever and that there 

 is no more summation than we find in the case of the specific dynamic 

 action of food in fever. 



Table 1 shows that there is a striking similarity in the results obtained 

 during the febrile periods in the three groups of typhoid patients. It 

 seems to make little difference whether the patients are on low diets or 

 high diets or whether they are fasting or digesting a recent meal. Normal 

 subjects on low diets after a period of a couple of weeks would exhibit a 

 lowered heat production. Normals studied a few hours after a hearty meal 

 have a distinctly increased metabolism. In typhoid fever the food does 

 not cause any significant rise in energy consumption. The reasons for 

 this will be discussed under the heading of specific dynamic action. The 

 practical application of this is that we need not be afraid of increasing 

 the fever by giving food. 



