METABOLISM IN FEVER AND CERTAIN INFECTIONS 121 



lion of 15.9 mg. per kg. (1.00 gm. per day). Shaffer and Coleman esti- 

 mate the increase in their cases about 20 per cent above normal. In con- 

 valescence both groups of investigators obtained results as low as 4 to 5 mg. 

 per kg. 



Myers and Fine have recently found that a rise in temperature in- 

 creases the rate at which creatinin is formed from the creatin: of muscle 

 tissue in autolysis and they believe that this accounts for the increased 

 excretion of creatinin in fever. 5. . 



Ewing and Wolf found that the creatin excretion of their patients 

 during the febrile period was high, in one case reaching one gram of 

 creatin nitrogen in twenty-four hours. Shaffer and Coleman also found 

 large amounts in toxic patients and believed that it was due to the destruc- 

 tion of the patient's own muscles. When they were able to give their high 

 calory diet they prevented the negative nitrogen balance and the creatin 

 elimination disappeared. 



In some fatal cases of typhoid Ewing and Wolf obtained high per- 

 centages of "rest" nitrogen. Coleman and Shaffer, who studied no fatal 

 cases, failed to find an increased excretion. The latter authors found a 

 moderate increase in the ammonia and uric acid at the height of the fever 

 but were unable to establish any relationship between the xanthin bases 

 and the febrile temperature. They found sugar in the urine in a very 

 small proportion of the cases considering the large amounts of carbohydrate 

 administered in the diets. Their patients showed a surprisingly constant 

 sulphur to nitrogen ratio in fever and convalescence excreting between 

 7 and 8 parts of the former to each 100 parts of total nitrogen. 



ADDENDUM TO METABOLISM IN TYPHOID FEVER 



Van't HofPs Law and the Basal Metabolism in Fever 



In a recent article on the basal metabolism in fever (1921) the 

 author had occasion to compare in graphic form the results obtained in 

 six different fevers (Fig. 15). All were studied in the respiration calorim- 

 eter of the Russell Sage Institute of Pathology under identical experi- 

 mental conditions, and all were plotted in the manner employed by McCann 

 and Barr in tuberculosis. The ordinates represented the rectal temper- 

 ature in degrees centigrade, the abscissae the level of the metabolism, 

 100 being the average normal, 150 representing 50 per cent above the 

 normal, etc. Each dot indicated a period of from one to three hours at 

 the given rectal temperature. The diagonal lines were drawn to show 

 the average direction of the swarms of dots. It became apparent that there 

 was a striking similarity between the various fevers, although they were 

 due to widely different causes. 



