96 EUGENE F. DU BOIS 



instance, the nitrogen elimination is discussed in typhoid fever, pneu- 

 monia, "heat puncture," etc. This method has great advantages but it 

 has seemed advisable to try a new method of approach and take up the 

 various important diseases one by one. The first disease so treated is 

 typhoid fever and the disturbances of metabolism which occur in this infec- 

 tion will be presented as fully as possible. . If one such disease is well 

 understood all other fevers can be treated much more briefly and emphasis 

 laid only on the points in which they differ from typhoid. 



Among the earlier reviews of the subject of fever we find that of Lie- 

 bermeister(&), who brought forward the conception that temperature regu- 

 lation was merely adjusted at a higher level than normal. Senator(fr) 

 emphasized the relative preponderance of protein in the metabolism in 

 fever during the years between 1873 and 1911. Wood, in Philadelphia, 

 showed the increased metabolism in fever by means of a calorimeter. In 

 more recent times we have the comprehensive work on the metabolism 

 of tuberculosis by A. Ott, and the discussion of the dietetic therapy of 

 fever by von Leyden and Klemperer(a). Garratt, in 1903, added an ex- 

 cellent review of the literature to his own studies or the organic and inor- 

 ganic constituents of the urine in fever. Kraus, in von Noorden's system 

 of metabolism, covered the whole subject of fever and infection with a care- 

 ful discussion of the results of work on animals. MacCallum, two years 

 later, wrote from very much the same viewpoint. The physiology of body 

 heat has been discussed in a classical manner by Tigerstedt(fr) in 1909. 

 Isaac Ott(6), of Philadelphia, one of the pioneer workers in the subject 

 of heat puncture, has published a little book on fever wiih a summary 

 of the literature. The most comprehensive discussion is that of P. F. 

 Richter(e) in Oppenheimer's "Handbuch der Biochemie." He reviews the 

 subject from the critical viewpoint of practical clinician who has done a 

 large amount of personal experimentation on animals and man, and has 

 had the benefit of long association with one of the pioneers of fever investi- 

 gation, Senator. This article has never received the attention it deserves, 

 but it will repay the reader not only in its subject matter but also as a 

 study of an excellent mode of treatment of a difficult review. Hewlett, 

 in his book on the functional pathology of internal diseases, has reviewed 

 the whole question of heat regulation and given the important references 

 up to 1913. Lusk(e), in his well-known text book on nutrition, has treated 

 the changes in metabolism in fever from the standpoint of the physiologist 

 and biochemist. 



Metabolism in Typhoid Fever 



It is not surprising that more work has been done on the metabolism 

 in typhoid fever than in any other infection. The disease has been prev- 

 alent and even at the present date can be found in most of the large 



