METABOLISM IE" FEVER AND CERTAIN INFECTIONS 147 



their work show the same curves that were observed in malarial fever. 

 There is the same enormous increase in heat production during the chill 

 and gradual increase in heat elimination during the fall and the same lag 

 in the change of the average body temperature as compared with the 

 rectal temperature. 



Cholera 



Asiatic cholera differs from other fevers in its profuse diarrhea, which 

 is accompanied by a striking dehydration of the tissues and diminution 

 of the urinary secretion. Acute nephritis with anuria is not uncommon, 

 and the clinical picture of uremia is often encountered. Sellards and 

 Shaklee have found a marked resemblance between the metabolism in this 

 uremic stage and diabetic coma. In the first place the cholera patients 

 show a high tolerance for alkalis and take as much as 90 gm. of sodium 

 bicarbonate before the urine becomes alkaline. Normal controls show an 

 alkaline urine after 5 to 10 grams. The ammonia in the urine is in- 

 creased both relatively and absolutely. There is a definite reduction of 

 the CO 2 in the blood and the tests indicated a diminished alkalinity of 

 the blood. They found some acetone and diacetic acid in the urine, but not 

 enough beta-oxybutyric acid to be compared with diabetes. Good results 

 were obtained therapeutically by the use of alkalis, and, if administered 

 early enough, they seemed to prevent the uremia. 



Rogers studied the salt metabolism in cholera and found that the 

 "rice water" stools contained, on an average, 0.53 per cent of chlorids. In 

 the blood serum the average content was 0.79 per cent, sometimes being as 

 low as 0.6 per cent. Recovering -cases had chlorids slightly above the 

 normal. It was obvious that the body was losing large amounts of 

 sodium chlorid on account of the diarrhea and the replacement of this by 

 means of hypertonic salt injections was found to improve the condition of 

 the patients. Valk and deLangen, working in Batavia, found that the 

 urea of the blood was between 60 and 590 mgm. per 100 c.c., with an 

 average of 350 mgm. These figures are astonishingly high, high even for 

 uremia. 



It is somewhat difficult to determine just which pathological factors 

 account for the various abnormalities above described. The kidney lesion 

 could explain the high blood urea and perhaps the high tolerance for 

 alkalis and other signs of acidosis. On the other hand, the dehydration 

 of the tissues may be a factor in producing these and in producing the 

 nephritis. 



It seems safe to assume a great concentration of the blood. In the 

 presence of all of these complications there is no way of finding out just 

 how much is due to the toxin of the cholera itself. 



