HYDROTHERAPY 861 



than in cold baths. In both cases Rubner found the respiratory quotient 

 rising from 0.86 to 1, as if the organism were called upon to do increased 

 work alike by cold and hot baths. Rubner also found that an hour after 

 a short hot bath or douche the volume of respired air and the metabolism 

 decreased considerably, and there is thus a considerable difference in the 

 after-effects of hot baths according to their duration. The absolute rela- 

 tion between the amount of heat applied and the increased heat production 

 varies according to different investigators (Linser and Schmid; Salomon), 

 and the differing activity of the sweat glands in physical regulation may 

 be an adequate explanation. Marked increases in oxygen consump- 

 tion, 40-111 per cent, are usually not accompanied by a proportional 

 increase in CO 2 output, with the result that the respiratory quotient 

 assumes low values. Similar low values are common in fever and 

 after violent exercise, suggesting, as in Lusk's ice bath experiment, the 

 complete exhaustion of glycogen and the breakdown of protein for its 

 formation. An increase in protein metabolism after hot baths was long 

 ago found in animals (Richter, Koch) and later in men (Formanek(a) ; 

 Topp). However, Tuttle (with Folin) in careful experiments was unable 

 to show any changes in metabolism as a result of hot baths. Since these 

 were usually hot air baths at 190 F. or below for 5 minutes followed by 

 indifferent and cold douches lasting one minute, or indifferent douches 

 followed by cold douches lasting between one and two minutes, it is possible 

 that the total heat effect was inadequate to produce changes in nitrogen 

 metabolism. They made no determination of gaseous metabolism. An 

 increase in protein metabolism according to Voit is not a primary result 

 of increased body temperature but follows upon the exhaustion of readily 

 available non-nitrogenous material since he found only a very small amount 

 of glycogen in the liver after artificial overheating and since the admin- 

 istration of 30-40 gm. of sugar prevented an increased nitrogen excre- 

 tion. This relation of rise in temperature to glycogen stores was not- 

 confirmed (Senator and Richter). It is probable that hyperthermia 

 does not always cause increased nitrogen metabolism, according to 

 Winternitz in only about one-third of the cases, and Linser and Schmid 

 found that in fever, carbohydrate administration limited nitrogen 

 elimination to a less extent than when the temperature was normal. Ac- 

 cording to these investigators the application of external heat even for 

 many days does not increase nitrogen output if the body temperature 

 remains at 39 C. or below, though when 40 C. is reached it usually 

 does, particularly if the heating process is abrupt. They do not agree with 

 Voit that it is a question merely of inadequate oxidizable material of a 

 non-nitrogenous nature, and consider that in fevers the toxemia plays a 

 part. The nitrogen loss as a result of hot baths is, according to Reilingh 

 de Vries, only momentary since he finds that during a considerable period 

 in which not excessively hot air baths were taken a compensatory nitrogen 



