METABOLISM IN FEVER AND CERTAIN INFECTIONS 131 



Wolf and Lambert have published elaborate analyses showing the par- 

 tition of nitrogen and sulphur in nineteen cases of pneumonia. During 

 the fever they found excessive amounts of creatinin, and in the severe 

 cases large amounts of creatin also. They conclude that the sulphur 

 excretion runs more or less parallel with that of the nitrogen but shows 

 considerable variation in some cases. 



Jobling, Petersen and. Eggstein(c), in studies on the serum ferments 

 and antiferments, have found that the crisis in .pneumonia is usually accom- 

 panied by a decrease in serum antiferment, a mobilization of non-specific 

 protease in the serum, an increase in serum lipase and decrease in the 

 proteoses and non-coagulable nitrogen of the blood. They believe that 

 the crisis is attended by the beginning of an active autolysis which is 

 dependent on an altered ferment-ant if erment balance. They consider that 

 the fibrin and leucocytic debris are potential sources of toxic substances. 



TABLE 8. BLOOD CHEMISTRY FINDING ix INFLUEXZAL PNEUMONIA (WELLS) 



Our knowledge of the changes in metabolism in influenzal pneumonia 

 is not yet extensive. Wells, in a recent article, has published a large 

 series of blood analyses showing that the epidemic disease with its com- 

 plicating pnumonia resembled in its metabolic aspects other fevers of 

 similar duration and severity. (Table 8.) 



Metabolism in Tuberculosis 



Tuberculosis in its milder forms escapes diagnosis so often that we 

 can be certain that many unsuspected cases have been included among 

 the so-called normal controls. It is doubtful if the metabolism departs 

 from the normal in the incipient stages of the disease. On the other 

 hand, the severe, fulminant types may resemble closely typhoid fever or 

 lobar pneumonia with the profound metabolic disturbances which char- 

 acterize these infections. Between these two extremes come the large mass 

 of tuberculous patients with involvement of various organs and toxemias 



