METABOLISM IN FEVER AND CERTAIN INFECTIONS 141 



production have been made by investigators who have attempted to find 

 out the pathological physiology of temperature regulation. Liebermeis- 

 ter(a) studied the carbon dioxid elimination in 1871 and ascertained the 

 more important facts by this simple method. Isaac Ott(&), of Philadel- 

 phia, made the first calorimetric measurements and Likhatscheff and 

 Avoroff, of St.. Petersburg, studied a malaria patient in the large Paschutin 

 calorimeter. Recently Barr and Du Bois have reported results obtained on 

 five patients studied in the Sage calorimeter.- Between paroxysms and 

 shortly before chills the average heat production of their patients was 14 

 per cent above the normal and the range was between 9 and 22 per cent 

 above normal. After treatment with quinin and a return to normal tern- 



4\ 



4d 

 39 J 

 36 

 37 

 36 



RCCTALTCMP. 



AV.BODYTCMP. 



S.f. 



Fig. 25. Composite curve constructed from calorimeter observations on four 

 patients in different stages of the malarial paroxysm. The continuous line shows the 

 rectal temperature; the dash line indicates the changes in the average body tem- 

 perature which, for purposes of calculation, is assumed to be one-half a degree lower 

 than the rectal temperature at the start of each observation. (Taken from Barr 

 and Du Bois.) 



peratures two of the patients gave normal figures, the others were 10 and 

 14 per cent above the average. The daily expenditure for malarial patients 

 of average size was estimated at 2,000-2,200 calories. 



Temperature Regulation in Malaria. Liebermeister found that the 

 heat production was greatly increased during a malarial chill and that 

 after the chill the temperature continued to rise although the heat produc- 

 tion suddenly dropped to nearly its former level. Ott confirmed Lieber- 

 meister's findings and demonstrated the great increase in radiation, con- 

 duction and especially vaporization during the period of falling tempera- 

 ture when there was but slight change in the heat production. Likhat- 

 scheff and Avroroff added many details to the picture, and in general con- 

 firmed the earlier results. The work of Barr and Du Bois was done with a 

 more accurate calorimeter which measured the oxygen consumption as well 

 as carbon dioxid. Rectal temperature readings were made every four 

 minutes and the experimental periods so adjusted that the metabolism 

 could be measured just before, during and just after the chill. Heat pro- 



