750 METABOLISM 



calls forth responses like those in a normal individual, yet at the fever 

 temperature itself there are none of the reactions which a normal individ- 

 ual would exhibit if his temperature were artificially raised to that level. 57 

 The adjustment of the temperature at the higher level is by no means 

 so perfect as it is at the normal level of health, so that a normal subject 

 is more resistant to the effects of cold than is a patient with fever. The 

 degree of response of the fever patient, however, varies considerably 

 from time to time ; a cold bath in typhoid fever, for example, lowers the 

 body temperature much less effectively at an early stage in the disease, 

 when the fever is more or less continuous, than later when it is becoming 

 of the intermittent type. In the third week of the disease the cold bath 

 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 605). 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- 



