METABOLISM IN FEVER AND CERTAIN INFECTIONS 137 



as the normal method of increasing heat elimination. Sweating without a 

 fall in temperature is puzzling and we cannot be altogether satisfied with 

 von Schrotter's suggestion that the toxins of the tubercle bacillus stimulate 

 the "sweating center" in the medulla and cord earlier than the "heat cen- 

 ters." He has some support for the theory in the occurrence of one-sided 

 sweats which affect only half the body. 



C 

 40 



39 



38' 

 100 



37 

 80- 



70 



60- 



50 



40 



30 



20 



10 



V 







I Z 3 

 ee 



Fig. 23. The mechanism of the rise and fall of body temperature in tuberculosis 

 as determined in a respiration calorimeter by McCann and Barr. Five different ex- 

 periments are arranged according to the curve of the rectal temperature (upper line). 

 The unshaded columns represent the heat produced as determined by the indirect 

 method. The shaded columns show the heat lost from the body by vaporization (solid 

 black) and by radiation and conduction (diagonal lines). Periods are for one hour 

 for each pair of columns. Note that the production greatly exceeds the elimination 

 during the rise of temperature. The fall of temperature is accomplished by an 

 enormous increase in radiation, conduction and especially vaporization. 



Staehelin(a) attacked the problem with a brilliant conception of its sig- 

 nificance but encountered such technical difficulties that his results do 

 not seem reliable. McCann and Barr tried in vain for several years to 

 catch a patient with one of these typical night sweats in the calorimeter. 

 They have, however, obtained much important data regarding heat pro- 

 duction and heat elimination during the rise and fall of body temperature. 

 Their results are shown graphically in Fig. 23. 



With a rising temperature the heat production increases and exceeds 

 the elimination. At the height of the fever the elimination catches up 

 with the production. During the fall there is an enormous jump in 

 radiation and conduction and especially in vaporization. 



