METABOLISM IN FEVER AND CERTAIN INFECTIONS 139 



TABLE 10. RESPIRATORY METABOLISM IN ERYSIPELAS 

 Summary of the calorimeter experiments of Coleman, Barr and Du Bois 



various fevers published the results in eight cases of erysipelas. A strik- 

 ing curve is shown in Fig. 24. Rolland in one case with a range of maxi- 

 mum temperature between 37.5 and 39 C. gave 46 calories per kilo- 

 gram in the food with 12.1 gm. of protein daily and found a negative 

 nitrogen balance averaging 0.67 grn. per day but considered this as evi- 

 dence against a toxic destruction. Kocher was able to administer to four 

 erysipelas patients diets containing 3,200-4,300 calories and only 1.8-2.2 

 gm. nitrogen. On such diets normal men, even though they performed 

 severe muscular exercise, came to a minimum nitrogen excretion of 2-3 gm. 

 per day. The erysipelas patients excreted 9-20 grams of nitrogen even 

 after several days of this diet. Grafe, one of the chief opponents of the 

 theory of toxic destruction, confirmed these results. He gave an ery- 

 sipelas patient a diet containing 66 calories per kilo and practically no 

 protein. The urinary nitrogen dropped from 25.9 gm. a day to 7.7 gm. 

 on the fifth day, but would not fall below this point. Coleman, Barr and 

 Du Bois found the same high nitrogen losses in patients who were receiv- 

 ing in the food more calories than the total expenditure as determined by 

 the calorimeter. In all of these experiments there are numerous indica- 

 tions that the nitrogen losses are not dependent on the high temperatures 

 since they continue for several days after the fever has disappeared. They 

 seem to prove in every possible way that there is some toxic agent which 

 causes a much higher metabolism of protein than in health. They show 

 also that the administration of abundant food, rich in carbohydrates, 

 diminishes the nitrogen losses. 



Analyses of Blood and Urine. Hollinger has found in erysipelas 

 blood sugar contents ranging from 0.114 to 0.131, about the same degree 

 of hyperglycemia as he found in other fevers. 



The various urinary constituents have been determined by most of 



