A STUDY IN MOIIBID AND NORMAL PHYSIOLOGY. 239 



tivelj the discharges of nitrogen and o.f carbon in fever, are the highest lluil cukl be taken ■ thus 

 those relating to nrea vver.. founded on observations of fevers of short duration, and ref..rred to 

 periods during which the cliaraclrrs of the febrile state showed themselves in their fullest intensity 

 It is still more nni.ortaul to remeudjer that the estimate of the febrile discharge of carbonic acid in 

 24 hours, is founded ou dctermiuaiions relating to the rate of discharge during the day only In 

 comparing the results with those relating to the same patients when free from fever, this error was 

 got rid of, for both sets of observations were made in exactly the same way. Consequently the 

 numbers given above, representing the relation between heat production on fever diet without fever, 

 and on the same diet in the febrile state, may be regarded as accurate; but if we compare either of 

 these numbers with that representing the heat production of health with adequate diet, a correction 

 is required. 



"Taken absolutely, both of them are unquestionably too high, for it is well known that the rate 

 of carbonic acid discharge is considerably higher in the day than in the night, so that any estimate 

 of the total discharge from measurenieiits made only during the day is certain to be excessive. 

 Pettenkofer and Volt found that in health the mean dhscharge during the whole 24 hours falls short 

 of the mean rate during the day by 14 per cent. If we make a deduction of 14 per cent, from the 

 estimated febrile discharge of carbonic acid which was taken as the basis of our estimate given above, 

 of the heat production in fever, wo have to take off 109 grammes from our total of 7K1) grammes. 

 Now the lieat discharge corresponding to each gramme of carbonic acid derived from the consump- 

 tion of fat is 3.23 k.-units; consequently if in fever tiie difference between day and night is as great 

 as in health, we must take off 352 (= 3.23 X 109) k.-units from our estimate. Thus corrected the 

 numbers stand thus : — 



Heat production in fever on fever diet . . . 2021 k.-units. 



Heat production in health on adequate diet , . 211S k.-units. 



"It is further to be borne in mind tiiat the state of things which is understood by the term 

 'adequate diet' is not that of ordinary life. By adequate diet is meant a diet which is just sufficient 

 to maintain nutritive equilibrium, i. e., to balance expenditure by income. Under ordinary circum- 

 stances we consume a great deal more food than is required for this purpose. In Professor Ilanke's 

 experiment, the diet of a young man of 24 consisted as we have seen of half a pound of meat, and 

 a pound of bread, besides small quantities of butter and eggs, etc., an amount of aliment which, 

 although it was proved experimentally to be 'adequate,' would, in ordinary language, bo described 

 as insufficient, and is certainly very inconsideral)le as compared with the usual requirements of 

 persons of the same age and sex. From the results of his experiments on more abundant dietaries 

 Kaiike inferred that the activity of the thermogenetic ])rocesses of his body could be increased to as 

 much as 2700 k.-units per diem, an amount far exceeding the highest estimate that could be made 

 of the possible production of heat in fever." 



It will be seen that tlie rcstilt reached by I'rof. Sander.son is in strict accord witli 

 that which has been arrived at in my experiments. According to liis calcidations 

 less heat is produced during fever in tlie linman organism than wlien the liealthy 

 man is fed up to the food limit, but very much more heat is produced in tlie febrile 

 state than when the man is kept without food. This certainly strongly corroborates 

 the conclusion which I have reached experimentally that tlie essential portion of 

 the fever is a derangement of nutrition, whereby the heat production at the expeu.se 

 of the accumulated material of the body is increased. 



The question may now be answered how can the apparent non-agreement of this 

 conclusion with that arrived at by Liebermeister and Leyden be explained. It 

 has already been shown that the methods of tliese inxestigators arc not above 

 suspicion. 



Granting, however, that their results are correct, they are not really in oppo- 



