METABOLISM IN FEVER AND CERTAIN INFECTIONS 105 



H.F. 

 NOV-20 



tion due chiefly to increased vaporization of water from the skin. (Fig. 5.) 

 The heat production diminishes, perhaps because of a change in the 

 chemical regulation or because the meta- 

 bolism is lower at lower temperatures 

 or because there is some abatement in 

 the toxemia which causes the fever. 



Surface Temperature. Unfortu- 

 nately we have little data concerning 

 the temperature of any parts of the 

 body except the mouth and rectum. 

 Coleman and Du Bois in most of their 

 typhoid experiments applied electrical 

 thermometers to the skin of the thorax, 

 one unit over the apex of the heart and 

 the other over the dome of the liver. 

 These were covered with pads of cot- 

 ton so that they did not measure the 

 actual skin temperature as influenced by 

 evaporation but gave readings which 

 probably approximated those of the sub- 

 cutaneous tissue. They found that these 

 surface thermometers indicated the 

 changes in the average body tempera- 

 tures slightly better than the rectal 

 thermometer, but their readings were 

 uncertain on account of the difficulty 

 of keeping them in sufficiently close con- 

 tact with the skin. If we look over their 

 results in 34 experiments in the light of 



the new method of determining the average body change we observe the 

 following : 



AVERAGE DIVERGENCE OF CHANGE IN TEMPERATURE OF RECTUM AND OF SURFACE OF 

 THORAX FROM TEMPERATURE OF BODY AS A WHOLE. 



Divergence of Rectal from Average Body Temperature 5.0 per cent 



" Surface " " " " 4.9 "" 



" Rectal from Surface 3.5 



We must remember that the "surface" thermometers were applied over 

 the heart and liver, and they may have been greatly influenced by these 

 two important viscera. They gave readings about one degree centigrade 

 below that of the rectum and the individual experiments as well as the 

 table of averages show that the surface and rectal curves agreed with each 

 other more closely than either agreed with the changes in the average body 

 temperature. This leads us to believe that the discrepancies between 



Fig. 5. Typhoid patients with fall- 

 ing temperature and rising heat 

 elimination. 



