138 EUGENE F. DU BOIS 



Data concerning the water elimination through skin and lungs have 

 been published by Schwenkenbecker. 



Blood Constituents. The blood sugar is increased in tuberculosis as in 

 other fevers. Hoi linger reports 153 mg. glucose per 100 c.c. blood in a case 

 of miliary tuberculosis. Roily and Oppermann found in one febrile 

 patient 114 mg. and in a patient with dyspnea but not fever 86 to 91 mg. 

 They believe that the sugar is increased in infectious diseases but not in 

 proportion to the temperature and that the hyperglycemia is caused in part 

 by the fever and in part by the toxins. 



Tileston and Comfort found a considerable retention of non-protein 

 nitrogen in the blood in two out of three cases of tuberculosis studied. 

 Schwartz and McGill found an increase in blood urea in two out of seven 

 cases. One patient with acute miliary tuberculosis had 60 mgm. urea 

 per 100 c.c. of blood. 



Janney and Newell have recently studied in detail a series of diabetic 

 patients showing pulmonary tuberculosis as a complication and have come 

 to the conclusion that the tuberculous lesion does best with judicious under- 

 nutrition. The patient should be kept with his urine sugar-free, but 

 fasting should be avoided as unnecessary and somewhat, dangerous. In 

 three cases of active tuberculosis they found the basal metabolism normal 

 and considered that the tendency towards increase from the pulmonary 

 lesion was offset by the lowered metabolism found in undernourished dia- 

 betics. Three patients with diabetes and inactive tuberculosis gave results 

 15 to 37 per cent below the average normal. 



Erysipelas 



In erysipelas there is frequently a severe grade of toxemia which re- 

 sembles that of typhoid fever, and it is not surprising that in the two 

 diseases there are striking similarities in the metabolism. The fact that 

 one is a streptococcus disease with its local lesion in the skin and the 

 other a bacillary infection with its local lesion in the intestine seems to 

 make but little difference. 



Total Metabolism. Several determinations of the total caloric output 

 have been made in facial erysipelas by Riethus and Graie(d)(h) and in 

 recent times by Coleman, Barr and Du Bois, using the Sage respiration 

 calorimeter. Riethus found an increase of 41 per cent in the metabolism, 

 Grafe in one case with a temperature of 39.5 found the heat production 

 40 per cent above the level which it reached after recovery. The results 

 obtained by Coleman, Barr and Du Bois are shown in Table 10. 



The respiratory quotients resemble those found in typhoid patients in 

 a similar state of nutrition and there is the same evidence of toxic destruc- 

 tion of protein. Loening in a comparative study of the nitrogen losses in 



