METABOLISM IN FEVER AND CERTAIN INFECTIONS 119 



TABLE 7. SPECIFIC DYNAMIC ACTION OF PROTEIN AND CARBOHYDRATE IN HEALTH, 

 FEVER AND CONVALESCENCE 



of a typhoid patient who eliminates 20 to 24 gm. nitrogen daily as in 

 the case of a convalescent or normal man excreting half this amount. 

 When we look at Table 7 we see that the meal raised the percentage of 

 calories obtained from protein only 5 per cent in the case of the febrile 

 patients and 13 and 10 per cent in the case of normal controls and 

 convalescents. The carbohydrate meal in almost all the cases decreased 

 slightly the percentage of calories derived from protein and substituted 

 carbohydrate. It seems probable that a combination of these factors serves 

 to mask the specific dynamic action of carbohydrate. The question was 

 admirably summed up by Lusk, in 1914. He called attention to the well 

 known fact that if the metabolism be increased by lowering the environ- 

 mental temperature there may be no specific dynamic action as usually 

 induced by ingested food. In like manner if the metabolism be raised in 

 fever, food ingestion may cause no increase. He also stated that since 

 protein metabolism in fever can never be reduced to as low a level as is 

 present in the normal organism, therefore protein ingestion in fever often 

 merely serves to replace the protein already breaking up in increased 

 quantity, and such protein ingestion would not then serve to increase the 

 heat production. 



The specific dynamic action of fat has not been sufficiently studied 

 in typhoid fever. Coleman and Du Bois gave one patient 79 gm. olive oil 

 and noted a rise of 3.4 per cent in the 2nd to 5th hours. 



Body Weight. There is nothing in the clinical aspect of typhoid fever 

 more striking than the rapid loss of weight of patients who are taking small 

 amounts of food. This subject is well reviewed by Coleman. (Fig. 14.) 



The reasons for this melting away of body substance have been dis- 

 cussed in the previous chapters. The loss of weight is, for several reasons, 

 greater than in the case of normal men who are fasting. The fever patient 

 has a greater caloric output than any fasting man who does not take a 



