THE CONSEQUENCES of a prolonged period of negative nitrogen balance in . surgical patient will depend upon the preoperative abundance of the protein reserves and the postoperative degree of their depletion.' 2,3,4,5,6 The significance of these reserves is even yet not fully realized despite the many recent studies indicating their dynamic relationship to the plasma proteins.7 8 Their amount and availability, however, constitute an important safety-factor in that, as a rule, a postoperative loss of nitrogen will be less serious, coming from abundant protein stores than from ones already depleted because of protracted debilitating disease. Moreover, if before operation upon a hypoproteinemic patient, the tissue-protein deficit can be at least partially corrected by the administration of high-quality proteins, the chances of suirvival should be considerably improved, provided that the mechanism responsible for blood protein synthesis has not been too severely damaged by the underlying pathologic process.Nutritional emphasis upon protein metabolism in surgical conditions has usually centered around such problems as the relationship of albumin loss, regeneration and replacement, to surgical shock, burns, blood loss, nutritional edema, wound healing, liver impairment and anesthetic injury, and comparatively little consideration has been given to the function of proteins in the prevention or amelioration of postoperative infection. Yet infection is an ever-present surgical menace, and the best surgical technic may be of slight avail in a markedly hypoproteinemic patient. Although infection may develop even under conditions of good nutrition, it is more likely to become menacing or even lethal when basic immunologic mechanisms are seriously impaired. For example, infection tends to become especially threatening in association with marked malnutrition, starvation or wasting disease, or with such chronic debilitating diseases as malignancy (especially of the gastro-intestinal tract), nephritis, cirrhosis of the liver, ulcerative colitis and the like, where inanition is actually a prominent part of the pathologic picture.9' 10 Nevertheless, such patients may be operated upon with little realization by the surgeon that they are in the danger zone of severe hypoproteinemia.*Read by invitation at the annual meeting of the American Surgical Association, May 3, 1944, Chicago, Ill. The experiments here reported were aided by grants from the John and
