METABOLISM IN FEVER AND CERTAIN INFECTIONS 143 



3. Chill. Rectal temperature rises abruptly; the surface of the body 

 becomes relatively and perhaps actually cooler; the average body 

 temperature rises somewhat less abruptly than the rectal temperature. 



4. Rising Temperature after Chill. Rectal temperature rises less rapidly 

 than during chill; the surface becomes warmer. 



5. High, Continuous Temperature. Rectal temperature is constant; sur- 

 face temperature rises steadily; patient feels hot. 



6. Falling Temperature. Rectal temperature falls much more gradually 

 than it rises. The surface temperature at first may continue to rise, 

 then to fall gradually for a period, and later to fall at about the same 

 rate as the rectal temperature. 



The heat production increases 100 to 200 per cent during the chill ; 

 immediately after the chill it falls to within 20 to 38 per cent of the 

 average basal level; with the falling temperature the heat production 

 drops to normal. 



During the period before the chill with constant temperature the heat 

 elimination, of course, equals the heat production. During the chill, in 

 spite of the enormous increase in heat production, the heat elimination is 

 the same as in the preliminary period. Almost all of the extra heat pro- 

 duced is stored in the body tissues. 



In the fourth period of rising temperature after the chill there is a 

 slight increase in heat elimination. In the fifth period of continuous 

 temperature heat elimination begins'to equal heat production. In the sixth 

 period of falling temperature the heat elimination is greatly increased, 

 chiefly by means of a large increase in the vaporization of water from 

 the skin. Of the total calories produced in this period the patient loses a 

 much larger percentage than normal through vaporization. On the other 

 hand, the percentage of calories lost through vaporization is not greatly 

 increased in its relationship to th& total heat elimination." 



It is interesting to note that the phenomena of the malarial chill are 

 duplicated almost exactly in the chills which follow the intravenous injec- 

 tion of proteose or foreign protein as has been shown in the unpublished 

 work of Cecil, Barr and Du Bois, who used, the same calorimeter in 

 the study of this form of experimental fever. 



Character of Foodstuffs Oxidized. In the calorimeter experiments 

 the respiratory quotients were all within normal limits, the highest being 

 0.88 and the lowest 0.72. There is an interesting rise in the quotient 

 during the chill, as is shown in the dash dot lines in Fig. 26. Before the 

 rise in temperature the patient was deriving about 17 per cent of the 

 calories from carbohydrate. Just before the chill and during the chill 

 the percentage rose to 58 and 52 per cent. After the chill the percentage 

 dropped first to 27 and then to 16. It is quite possible that an "Aus- 

 pumpung" of CO 2 due to hypernea at the beginning of the rigor makes 

 the respiratory quotient a little too high and that a compensatory retention 

 at the end of hypernea makes it a little too low, but it is safe to say that 



