METABOLISM IN FEVER AND CERTAIN INFECTIONS 113 



They were never able to bring their typhoid patients into nitrogen balance 

 although they gave as much as 3,000 calories on some days and Shaffer 

 and Coleman, using diets especially rich in carbohydrate, were the first 

 to bring typhoid patients into nitrogen balance by giving 68 to 85 calories 

 per kilogram per day (3,500 to 5,200 calories). The chart of one of their 

 patients Z-O is given in Fig. 11. It will be noticed that the nitrogen 

 balance became strongly negative when the caloric intake was diminished 



Fig. 11. Typhoid patient Z-O, studied by Shaffer and Coleman. He was main- 

 tained in nitrogen equilibrium by giving over 5000 calories per day. The line of 

 dashes represents the urinary nitrogen plus 15 per cent of the food nitrogen, which 

 is a liberal estimate for the amount excreted in the feces. 



by reducing the carbohydrates and that equilibrium was not regained until 

 the third day of the renewed 5,000 calory diet. 



Grafe and others had taken the stand that the experiments of Shaffer 

 and Coleman proved that there was no toxic destruction of protein in 

 fever since nitrogen equilibrium could be attained. Grafe pointed out 

 that protein furnished about the same percentage of calories in fever as 

 in health. Shaffer and Coleman in New York and later Kocher, working 

 in the clinic of Friederich v. Miiller, were able to prove that fever patients 

 could not be reduced to the nitrogen minimum of healthy persons even 

 though they were given an amount of food which would more than cover 



