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EUGENE F. DU BOIS 



The specific dynamic action of food in tuberculosis has received little 

 attention up to recent times. McCann and Barr have studied the effect 

 of a meal consisting of 350 gm. chopped meat containing 70 gm. protein 

 and 28 gm. fat. The results are shown graphically in Fig. 22. One 

 tuberculous patient in three hours following this rather large meal of 

 meat showed an average increase in heat production of 16 per cent, a second 

 patient 18 per cent. Normal controls gave practically the same rise, aver- 

 aging 21 per cent. Such an increase in the oxidative processes throws 

 additional work on the heart and lungs. It may possibly act like mild 



Fig. 22. The specific dynamic action of protein in tuberculosis patients as 

 compared with normal controls. In each experiment the first column shows the basal 

 metabolism, the subsequent columns show the heat production 1-6 hours after a meal 

 of 350 grams of chopped beef. (Taken from McCann and Barr.) 



exercise in raising the body temperature to a light extent. The extra heat 

 would be helpful only in the case of a patient exposed to extremely cold 

 weather. McCann and Barr issue the timely warning that clinicians must 

 remember the specific dynamic action when giving large amounts of food. 



We know very little about the specific dynamic action of fats and carbo- 

 hydrates in chronic tuberculosis, but there is no reason to doubt that large 

 meals of these substances cause a considerable rise in metabolism just as 

 in health. We have seen that the specific action of protein and carbo- 

 hydrate was found to be less than normal in typhoid fever, probably being 

 masked by the great increase in protein metabolism found in this disease. 

 Severe cases of tuberculosis may resemble typhoid fever in this respect. 



Temperature Regulation in Tuberculosis. Two striking clinical phe- 

 nomena of tuberculosis are the rapid fluctuations in body temperature and 

 the night sweats, von Schrotter, in Ott's book, reminds us that we must 

 not confuse the night sweats of an early case in which the temperature 

 fluctuations are slight with the profuse sweating of advanced cases in 

 which there are sharp remissions in the temperature. With failing tem- 

 perature we find sweating in almost all diseases, so this is easily explained 



