126 EUGENE F. DU BOIS 



The respiratory metabolism was studied by Kraus, and later by 

 Riethus who, grouping his figures with those of Kraus, estimated in one 

 group of seven pneumonia patients, an average increase of 20 per cent 

 above the normal and in another group of six, an increase of 55 per cent. 

 Svenson, using technic which seems to have been excellent, found two 

 patients with basal metabolism 50 and 70 per cent higher during pneu- 

 monia than after recovery from the disease. Grafe obtained results which 

 were somewhat lower, but his patients were studied late in the febrile 

 attack. Roily, on the second day of the disease, found a respiratory 

 quotient of 0.707 and an oxygen consumption of 5.98 c.c. per kg. and 

 Min., which he considered about 50 per cent above the average normal. 



Svenson's respiratory quotients in the febrile period were 0.702 and 

 0.700; in convalescence they rose to a level over 0.90 about ten days after 

 the crisis. 



In general, we can state that the respiratory metabolism in lobar 

 pneumonia resembles that of severe typhoid fever with the same phenom- 

 ena in convalescence. The heat production during the acute stages may be 

 slightly greater but the period of increase is not so long. 



Nitrogen Excretion. For many decades attention has been directed 

 towards the epicritical rise in nitrogen elimination which may occur a few 

 days after the crisis. This is usually ascribed to the resolution of the pneu- 

 monic exudate with its rich protein content. In considering this subject 

 we must remember that there is a curious retention of chlorids in the 

 body during the fever with increased elimination after the crisis. The 

 possibility of such a retention of nitrogenous metabolites must be con- 

 sidered also. A striking example of the epicritical rise in nitrogen is 

 shown in Fig. 18, taken from the work of Svenson. 



Loening did not find the epicritical rise as great as most of the earlier 

 investigators. He believed that it could be accounted for by the resorption 

 of the exudate on the strength of the following analyses obtained in the 

 lungs of a patient dying of lobar pneumonia. 



Kocher, using his diet containing 3,400 to 4,200 calories and 2 to 4 

 grams of nitrogen studied two cases to ascertain the nitrogen minimum. 

 During the fever the first patient excreted on an average 7 gm., the 

 second patient 19.5 gm. of nitrogen a day. The second patient showed no 

 drop in nitrogen excretion until the third day "of normal temperature, 

 when it reached 13.6 gm. and then fell by the 5th day to 11.3. Many 



