616 FEVER 



should be recalled in this connection that if a healthy man 

 steps into a cold bath, a contraction of the peripheral ar- 

 teries may result in a transitory rise in the body tempera- 

 ture ; after leaving the bath the blood flows in full propor- 

 tion to the surface and the skin reddens. In chills the skin, 

 as the result of vascular contraction, looks bloodless, and in 

 response to stimulation of the cutaneous nerve endings which 

 are sensitive to cold, the production of heat in the muscles 

 increases reflexly. Eeplacement of the stimulus from cold 

 by a warm covering about the body may in conformity 

 reduce the production of heat. 20 



Protein Destruction. Proceeding with consideration of 

 the metabolic processes in fever, we come first to the problem 

 of febrile protein destruction. 21 



Undoubtedly fever may be associated with a marked 

 protein disintegration which manifests itself by an in- 

 creased urea elimination. Frequently this latter feature 

 fails to put in appearance until after the fever has already 

 declined. Thus, for example, Naunyn observed in a case of 

 typhus exanthematicus on the tenth day of the febrile course 

 a urea elimination of only ten grams, but on the fourteenth 

 day, with the temperature down to normal, the urea excre- 

 tion reached ninety grams. It is not an easy matter to 

 formulate a proper interpretation of an " epicritical nitrogen 

 elimination " of this sort. It cannot be held that the elim- 

 ination of already formed urea has been retarded ; Naunyn 

 has convinced himself that urea accumulation does not take 

 place in the tissues of febrile individuals, and that the body 

 in the state of fever can readily excrete urea, which is itself 

 very diuretic when experimentally introduced into the cir- 

 culation. It seems much more plausible on the other hand 



*Cf. Graham Lusk, 1. e., pp. 288-292. 



a Literature upon Protein Metabolism in Fever: C. Speck, Ergebn. d. 

 Physiol., 2", 27-30, 1903; F. Kraus, Noorden's Handb. d. Pathol. d. Stoffw., 1, 

 590-610, 1906; L. Krehl, Pathologische Physiologic, 5th Ed., 491-495, 1907; 

 Graham Lusk, Ernahrung und Stoffwechsel, 285-288, 294-302, 1910; P. F. 

 Richter, Handb. d. Biochem., 4', 112-119, 1910. 



