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EUGENE F. DU BOIS 



considerable amount of exercise. The fever patient does not show a pro- 

 gressive reduction in metabolism such as we find in starvation. The 

 typhoid patient may have a negative nitrogen balance of 10 to 20 gm. a 

 day, showing that he is losing much larger amounts of body protein than 

 the professional faster. The latter,loses relatively more fat, a tissue which 

 contains a smaller proportion of water than body protein. The fever 

 patient is losing more water through skin and lungs on account of the 

 higher heat elimination and also during the periods of falling temperature 

 there is a specific increase in the water vaporized from the skin. 



Patients who are given the high calory diet in amounts which cover 

 the energy requirement do not lose weight and sometimes gain during 



Fig. 14. Weight curve of typhoid patient who took but little food during the 

 early part of his illness. After the 18th day of his disease the calories were in- 

 creased rapidly and the patient began to gain weight. (Taken from Coleman, 1912.) 



the fever, as is shown in Figs. 9, 11 and 12. It is possible that the 

 gain in weight may be partly due to a retention of salt or an increased 

 blood sugar which cause a retention of water, but it is difficult to see how a 

 patient could help gaining weight if he were given more protein, fat and 

 carbohydrate than he oxidized for a period of a week or more. There are 

 no visible signs of significant changes in the water content of the body 

 in any typhoid patients except those who are partly dehydrated on account 

 of toxemia and insufficient fluids in the diet. The technic of establishing 

 an accurate water balance in fever is so difficult that no one has yet made 

 satisfactory determinations. The mere measurement of the fluids of the 

 diet and the volume of the urine may give a water balance with an 

 error of 50 to 100 per cent. 



Urinary Constituents. Complete analysis of the urine of typhoid 

 fever patients will be found in the works of Ewing and Wolf, and Shaffer 

 and Coleman. The creatinin excretion is increased during the period of 

 fever, falling with or before the drop in temperature and establishing itself 

 at a low level during convalescence. Shaffer found that normal subjects 

 excreted 5.4 to 11.7 mg. creatinin per kilogram of body weight. In the 

 febrile stages of typhoid Ewing and Wolf found one patient with an excre- 



