METABOLISM IN FEVER AND CERTAIN INFECTIONS 109 



who receive less food show quotients which indicate a degree of starvation 

 as complete as that found in professional fasters three or four days after 

 their last food. Patients who are well fed seem to differ in no way from 

 normals, but there is evidence to indicate that they must be given more 

 food than a normal man to bring the quotients to the same level. We 

 must not forget that the pathologically high metabolism of protein has 

 but little effect on the respiratory quotient. 



In convalescence from typhoid the body rapidly replenishes its gly- 

 cogen deposits if these have been depleted and perhaps is able to store 

 larger amounts than normal. The quotients rise to an extraordinary level 

 and the metabolism which was on a protein-fat basis in fever appears to be 

 on a protein-carbohydrate basis. For instance Howard F., on December 

 6th, 14 hours after his last meal, had a quotient of 0.96, indicating that he 

 was deriving 14 per cent of his calories from protein, 6 per cent from fat 

 and 80 per cent from carbohydrate. The reason for this becomes apparent 

 when we note that he received 1,380 carbohydrate calories on the previous 

 day and find that the calorimeter indicated that his total requirement for 

 the 24 hours was only 1,320 calories. If a convalescent with the character- 

 istic enormous appetite consumes more carbohydrate than he can possibly 

 oxidize it is not surprising that he should be converting some of it into fat 

 many hours after the last meal. We should like to know if this occurs after 

 long periods of starvation, either complete or partial, in normal men. The 

 phenomena of the recover)' from starvation have been strangely neglected. 



Carbohydrate Metabolism. The subject of the oxidation of carbo- 

 hydrates has been covered in the paragraphs which discuss the respiratory 

 quotient. There is no evidence of anything abnormal either quantitatively 

 or qualitatively. Occasionally a slight glycosuria develops during typhoid 

 fever. One such case, Frank W., was studied by Coleman and Du Bois. 

 On the 18th day of his disease he excreted 32 grams of sugar, but his 

 respiratory quotient was .86 and he derived 47 per cent of his calories from 

 carbohydrate. This proved that the glycosuria was not of a diabetic type, 

 and indeed the patient never showed glycosuria after leaving the hospital, 

 although the urine was examined repeatedly during the course of the next 

 few years. Such temporary appearances of sugar in the urine are probably 

 due to the somewhat increased level of blood glucose which has been found 

 in typhoid and other fevers by Hollinger, Roily and Oppermann, Freund 

 and Marchand and others. 



The question of the rate of oxidation of ingested carbohydrates will be 

 discussed under the heading of the effect of foods in fever. 



Fat Metabolism. We have seen that patients who are given small 

 amounts of food derive a large proportion of their calories from body fat, 

 just as in the case of a starving man or a diabetic. In typhoid, however, 

 the destruction of protein i's greater than in either of the other two condi- 



