METABOLISM IN FEVER AND CERTAIN INFECTIONS 117 



indicate that the toxins of the disease affect the cells of the stomach and 

 also tend to diminish the hunger contractions. The appetite is doubtless 

 affected also by the wretched condition of the mouth, which becomes 

 apparent a few days after the onset of the fever unless great care be taken 

 by the nurses to keep the mouth scrupulously clean. The coated tongue 

 and sordes on the teeth are not an essential part of the disease, and when 

 the nursing is adequate one may see a dozen typhoid patients in succession 

 with tongues and teeth as clean as those of normal men. In such cases 

 the appetite will return and the patients will consume large amounts of 

 food if properly administered. 



The older writers on typhoid fever speak of diarrhea with "pea soup 

 stools" as characteristic of the disease, but in these days of liberal feeding 



Fig. 13. Temperature chart of typhoid patient, Charles N., studied by Du Bois. 

 The columns show the average daily weight of fat, carbohydrate and protein in the 

 food; the solid bases represent the amounts unabsorbed. The feces were collected 1 

 in three-day periods. 



it is rare to find diarrhea, and the stools resulting from daily enemas are 

 surprisingly normal. As long ago as 1882 von Hjosslin found that typhoid 

 patients absorbed food almost as well as normal men, although most of his 

 patients had diarrhea. Several of his subjects during periods of practical 

 starvation excreted in the feces 0.8 to 5.0 gm. of ether extract and 0.4 to 

 0.8 gm. nitrogen daily, this amount probably being derived from the 

 intestinal tract itself. Several Russian investigators of Chudnowsky's 

 clinic studied the absorption of food in typhoid fever. Aikinov, who in- 

 cluded in the dietary 20 gm. blackberries, found from 4 to 6 gm. nitrogen 

 in the stools and Grudziev, who gave a very liberal diet with 30 to 45 gm. 

 nitrogen, found 4 to 11 gm. in the stools. These high figures are ex- 

 ceptional and are due either to irritating food or unusual amounts of 

 protein in the ration. The influence of the high-calory diet of Shaffer and 

 Coleman was studied by Du Bois and later by Coleman and Gephart. 



