144 EUGENE F. DU BOIS 



carbohydrates furnish an increased proportion of calories for the muscular 

 work of the chill just as they do for other muscular exercise. 



The destruction of body protein does not seem to be as great in 

 malaria as in the continued fevers. Sharpe and Simon in a recent study 

 of transient fevers have found during the rise of temperature a tendency 

 for a rise of urinary nitrogen and less uniformly of creatinin. Three of 

 the patients studied by Barr and Du Bois showed negative nitrogen 

 balances when they were receiving in their food more calories than they 

 required to cover the heat production as determined by calorimetric tests. 

 This points towards a toxic destruction of protein, but variations in the 

 kidney function may obscure the true protein metabolism. 



Direct and Indirect Calorimetry. LitkatschefT and Avroroff did not 

 compare the heat production as determined by the method of indirect 

 calorimetry with the results obtained by the direct method but from 

 their data it is possible to make the calculation. On the day of normal 

 temperature the direct method was 6 per cent higher than the indirect, 

 on the two febrile days 6 and 12 per cent lower. This is good agreement 

 when one considers the difficulties of their methods. With the Sage calo- 

 rimeter the agreement was usually good when all the experiments were 

 taken together the total divergence being less than one tenth of one per cent. 

 In the febrile periods alone the total divergence was 0.7 per cent, but in 

 some of the individual periods with great body temperature changes the 

 differences were enormous, as is the case in all fevers. 



Chlorids and Phosphates in Malaria. Malarial fever occupies an 

 anomalous position in regard to the excretion of chlorids and phosphates. 

 In almost all other fevers there is a marked decrease in the excretion of 

 chlorids, usually accompanied by an increase in the excretion of phos- 

 phates. It has been shown that the blood chlorids are decreased in pneu- 

 monia so that the disturbance does not seem to be due to the kidneys but 

 to a retention in the tissues. In malaria, on the other hand, Terray, 

 Bookman and numerous other investigators have shown that the chlorid 

 excretion is greatly increased during the febrile attacks and decreased in 

 the intervals of normal temperature. The curve for phosphates shows a 

 decrease during fever and a rise in the intervals. It would be interesting 

 to follow the curves for these substances in the blood and study the kidney 

 function. 



Fever Caused by the Parenteral Injection of Foreign 



Proteins 



It is hardly within the scope of this article to discuss fully the question 

 of the parenteral injection of foreign proteins, as this would lead too far 



