134 EUGENE F. DU BOIS 



considerably greater than was found in other fevers, may have been due 

 to the fact that almost all of the observations were made with a rising tem- 

 perature and under such conditions there is a tendency for the calculation 

 by the direct method to be too low since the changes in the rectal tem- 

 perature are not equal to the changes in the average body temperature. 



Character of Foodstuffs Oxidized. In all the modern work the re- 

 spiratory quotients are the same as those found in normal people of 

 similar state of nutrition. There are no indications of abnormal metab- 

 olism of fat or carbohydrate. There is, on the other hand, evidence of a 

 toxic destruction of protein in many cases. This does not seem to be as 

 great as in the more acute fevers. May, in Ott's book on the chemical 

 pathology of tuberculosis, devotes seventy pages to this subject, repro- 

 ducing many tables of experimental data from various investigations. In 

 discussing the afebrile cases he concludes that many tuberculous patients, 

 or rather all of them at some time in the disease, show a pathological 

 increase of protein metabolism in the sense of a toxic destruction. This 

 he believes is dependent on the production and resorption of poisonous 

 substances from the areas of tuberculous involvement. His tables of 

 nitrogen balances in febrile cases show consistent losses, sometimes as 

 great as 10 to 12 grams a day, but the data regarding the caloric intakes 

 are incomplete. The injection of tuberculin seems to have no effect unless 

 it raises the temperature, in which case there is an increased tendency 

 towards a negative nitrogen balance. 



Holland has been able to bring five tuberculous patients with various 

 types of the disease into nitrogen balance by administering 33 to 50 

 calories per kilogram per day in the food with 9 to 13 grams of nitrogen. 

 It is not certain whether or not this ration covered the caloric output. 

 Kocher gave three patients diets containing 2,900 to 3,800 calories and 

 1.1 to 2.3 gm. nitrogen and found that they excreted 12 to 18 gm. nitrogen 

 in the urine, or about five times as much as normal men under similar 

 circumstances. McCann and Barr repeated these experiments in the 

 nitrogen minimum in tuberculosis, giving more calories than were required 

 to cover the output as determined in the calorimeter. They were unable 

 to reduce the excretion below 5 to 6 gm. The results in a case of acute 

 miliary tuberculosis with a cavity at the apex of the right lung are shown 

 in Fig. 21. The nitrogen minimum was much lower than in other fevers 

 with the same level of temperature but not so low as normal. 



Sputum. Ott has given a careful review of the chemistry of the 

 sputum in tuberculosis. Many investigators have studied this subject. 

 Among them Lanz has found nitrogen losses ranging between 0.2 and 1.7 

 gm. a day with an average of 0.68 per cent. Such losses,, when continued 

 for months, are of considerable importance. This nitrogen does not rep- 

 resent recently metabolized protein as does the urinary nitrogen, but 

 rather the loss of tissues built at some previous period. 



