METABOLISM IN FEVER AND CERTAIN INFECTIONS 115 



subject's own body. We have seen that Kocher reduced the protein to 2 

 per cent. After a meal containing a large amount of meat a normal man 

 may derive more than 4.~> per cent of his calories from protein. Any 

 percentage between these two points may be normal. The factor of 

 muscular work which causes a great rise in total heat production scarcely 

 raises the protein metabolism. Therefore the comparatively slight in- 

 crease of heat production due to fever cannot account for the high nitrogen 

 losses. 



A normal man can be brought into nitrogen equilibrium if given suf- 

 ficient food to cover the caloric requirement. This is accomplished without 

 delay if the nitrogen intake is not greatly reduced but maintained at about 

 15 grams a day, which is the amount'usually consumed by most individuals 

 in health. If the nitrogen intake is suddenly reduced to the minimum of 

 3 to 5 grams it may take four or five days before the equilibrium is 

 established at the low level. As we have seen above, this cannot be accom- 

 plished in typhoid fever. Coleman and Du Bois have arranged in a 

 table (Table 4) their five patients who showed negative nitrogen balances 

 when they were receiving 11 to 16 grams of nitrogen daily and calories 

 more than enough to cover the daily expenditure which was actually 

 determined in each case by measurements in the calorimeter. In a previ- 

 ous paper these same investigators had compiled a table showing the 

 amount of food required to bring typhoid patients into nitrogen equi- 

 librium. (Table 5.) From this it is clear that it requires about 58 to 85 

 calories per kilogram in the food to bring the patients into nitrogen balance 

 although they produce on an average about 40 calories per kilogram, allow- 

 ing for the moderate amount of muscular work performed by typhoid 

 patients. 



TABLE 4. CHART SHOWING NEGATIVE NITROGEN BALANCES IN TYPHOID PATIENTS WHO 

 RECEIVE FOOD CALORIES IN EXCESS OF CALCULATED HEAT PRODUCTION 



1 Figures given are averages for twenty-four hours. 



2 Taken from Coleman and Du Bois, 1914. 



