106 EUGENE F. DU BOIS 



direct and indirect calorimetry are due to unrecorded calories gained or 

 lost in the arms and legs. Every clinician knows that the extremities may 

 be relatively cold in fever patients. The whole subject of temperature 

 changes in various parts of the human body needs further investigation. 



Water Metabolism. The typhoid patients studied by Coleman and 

 Du Bois voided daily between 600 and 2,400 c.c. urine, averaging about 

 1,500 c.c. At the same time they excreted daily through skin and lungs 

 about 700 grams of water. In some cases they lost more through skin and 

 lungs than through the kidneys; for instance, Morris S., on November 

 26th, voided 780 c.c. in 24 hrs. and vaporized 105 c.c. during three hours in 

 the calorimeter, which is at the rate of 840 c.c, for the day. Soderstrom 

 and Du Bois compared all the patients studied in the Sage Calorimeter 

 whose water elimination could be determined accurately and found that 

 normal men under the standard conditions vaporized from skin and lungs 

 an average of 29 grams an hour, losing in this manner 24 per cent of the 

 total heat produced. Typhoid patients with rising temperature lose 22 per 

 cent, typhoids with falling temperature 28 per cent, and in convalescence 

 21 per cent. Many febrile patients eliminated over 35 grams per hour but 

 the ventilation system of the calorimeter was not able to remove the water 

 vapor as fast as it was formed and the humidity of the chamber increased 

 until it was higher than the standard conditions under which the normals 

 were studied. Since the calorimeter can take care of the water vaporized 

 by a normal man at rest this in itself shows that the vaporization is 

 increased in typhoid fever. It is doubtful if the percentage of heat lost 

 through vaporization is increased except when the temperature falls. 



There is little evidence that the power of the kidneys to eliminate 

 water is diminished in typhoid fever. Visible edema is rarely encountered 

 and the invisible edema that is said to accompany high carbohydrate 

 diets cannot amount to more than a few kilograms of retention. 



Clinicians who estimate a water balance in a patient record under 

 "Intake" only the fluids of the diet and under "Output" only the urine. 

 In normal people the so-called solid foods furnish large amounts of water 

 not only through their percentage content of water but also through the 

 water formed from the oxidation of the carbohydrate, fat and protein.. 

 For all practical purposes we are close enough in our calculations if we 

 estimate that 100 grams of solid food furnishes 100 grams of water to the 

 organism. In fever this source of water is greatly diminished so the 

 patient must be given fluids to compensate this loss in addition to the 

 extra amount needed to balance the increased elimination through skin 

 and lungs. 



The Respiratory Quotient. The respiratory quotient obtained by 

 dividing the volume of CO 2 produced by the volume of O 2 consumed gives 

 us valuable information regarding the character of the food-stuffs being 

 metabolized in the body. If we know the excretion of nitrogen in the urine 



