CONTROL OF BODY TEMPERATURE AND FEVER 723 



more readily brings down the temperature and keeps it down for a longer 

 time than during the first or second week. The mechanism for heat loss 

 is also deranged in fever, which explains the rise in temperature that is 

 likely to follow the performance of even moderate muscular exercise or 

 the taking of too hearty a meal in tuberculous and convalescent typhoid 

 patients. 



Changes in the Body During Fever 



In seeking for the cause of fever which is evidently of an obscure 

 nature, it is necessary to collect all the information we can regarding 

 the metabolic changes that are then occurring in the animal body. A 

 few of the most significant facts that have so far been collected may 

 be mentioned here. Some of the most important concern the dis- 

 turbance in nitrogenous equilibrium caused by the considerable loss of 

 nitrogen which takes place in fever patients when they are fed on 

 the usual hospital diet prescribed for such cases. This loss of nitro- 

 gen is no doubt the result of the partial starvation in which the pa- 

 tient is kept; for it has been shown by Shaffer and Coleman 55 that 

 patients with typhoid fever may be maintained in nitrogenous equi- 

 librium by feeding them with relatively large amounts of carbohy- 

 drate, which acts by protecting the protein of the body from disintegra- 

 tion (see page 571). Even with a diet excessively rich in carbohydrates 

 that no more than covers the calorie requirements of the patient, nitrog- 

 enous equilibrium has also been attained. The protein minimum to 

 which fever patients can be reduced is nevertheless considerably higher 

 than the minimum in normal individuals. 



From the above results as a whole, it is probably safe to conclude that 

 there is a specific destruction of protein going on in the body during fever. 

 Further evidence of such a destruction is furnished by the presence in 

 the urine of excessive amounts of creatinin, of purine bases, and, it is 

 said, of incompletely hydrolyzed proteins, such as the albumoses (pro- 

 teoses.) Moreover, when the fever suddenly terminates in crisis, there 

 is a marked increase in the excretion of urea (the epicritical urea in- 

 crease), which indicates that an extensive deamination of protein build- 

 ing stones (amino acids) is occurring. The so-called "diazo reaction " 

 obtained in the urine during the fever is also believed to depend on the 

 presence of abnormal protein-disintegration products. 



As to the specific cause of the increased protein disintegration, little 

 is known. Several factors may operate: (1) the partial starvation of the 

 patient, entailing an increased breakdown of protein to meet the calorie 

 requirements; (2) the high temperature, which in itself may stimulate 

 increased protein metabolism, for it has been shown that, when normal 



