118 



EUGENE F. DU BOIS 



Their results are shown in Table 6 and Figure 13. 



TABLE 6. ABSORPTION OF FOOD IN TYPHOID FEVEB 



Normal controls and typhoid patients on the Shaffer-Coleman high calory diet 

 studied by DuBois and by Coleman and Gephart. 



In general, we can say that von Hosslin has been confirmed in his state- 

 ment that food is absorbed as well in fever as in health. 



The work of Torrey on the intestinal flora in typhoid has been of great 

 interest. When patients were given a high calory diet, rich in carbo- 

 hydrates, he found that the flora became simplified in regard to the 

 number of bacterial types and the fermentative organisms, particularly 

 the Bacillus acidophilus, became dominant. If the flora originally showed 

 a distinct putrefactive tendency the change was not great, but with a 

 favorable initial flora the high carbohydrate diet finally resulted in stools 

 that resembled those of normal infants in the dominance of the Bacillus 

 acidophilus and even the presence of the Bacillus bifidus. This opens up a 

 new field of speculation in regard to the effect of the fecal flora on metab- 

 olism. It is not at all improbable that many of the phenomena ascribed 

 to changes in diet are really secondary to the establishment of a new type 

 of flora in the intestine. 



Specific Dynamic Action of Food in Typhoid Fever. We have seen 

 that during period of high temperature the caloric output is about the 

 same in a group of liberally fed patients shortly after food as in a group 

 of patients on low diets 14 or more hours after the last meal. In con- 

 valescence the patients studied shortly after food showed a distinctly 

 higher metabolism, just as we find in the case of normal subjects. The 

 specific dynamic action of food as described by Rubner manifests 

 itself by an increased heat production during the time when the products 

 of digestion are circulating in the blood and being consumed in the tissues. 

 Coleman and Du Bois studied in the calorimeter the cause of the apparent 

 absence of specific dynamic action in fever. Their results, as given in 

 Table 7, show that the specific dynamic actions of protein and carbohydrate 

 were much less than in the case of normal men or convalescents. It is not 

 difficult to realize that the addition of a meal containing 8 to 9 grams of 

 nitrogen would not increase the protein metabolism as much in the case 



