148 EUGENE F. DU BOIS 



Miscellaneous Infectious Diseases of Man 



Syphilis. There are few infectious diseases of more importance than 

 syphilis, yet the studies of the metabolism in this condition are surpris- 

 ingly scant. The comparatively slight constitutional effects and the 

 chronicity of the disease have probably led investigators to believe that 

 the abnormalities in metabolism were so small as to be negligible. The 

 early work of Jakovleff and of Radaeli indicated an increase in the 

 nitrogen losses during the period of the initial lesion and later during the 

 generalized eruption with some diminution of the absorption of protein 

 by the intestines. Their experiments were made with such large protein 

 rations that the changes in nitrogen output are not conclusive. 



We are indebted to a young Finnish dermatologist, Cedarkreutz, for 

 an excellent piece of work done in 1902. He used Landergren's method 

 of specific nitrogen hunger about twelve years before its adoption in other 

 medical clinics as one of the best methods of determining small changes 

 in the nitrogen metabolism. This diet contained practically no protein 

 but plenty of fats and carbohydrates to cover the patient's requirement. 

 After four days of this ration the normal controls were excreting 3.4 to 4.0 

 gm. of nitrogen per day. One syphilitic patient with a secondary eruption 

 excreted 4.9 and 4.5 gm. K. One woman with roseola, who had slight 

 fever on the first two days of the diet, did not fall below 7.3 gm. Five 

 experiments on other patients with early syphilis gave normal results. 

 He found that mercury and potassium iodid had no effect on normals and 

 that the relationship of urea and uric acid excretion was normal in all 

 the syphilitics. On the whole, the findings of Cedarkreutz indicate that 

 there is little toxic destruction of protein in early syphilis, although one of 

 his patients with fever showed that it may be present. 



The work of Tileston and Comfort and of Schwartz and McGill 

 indicates that most patients with syphilis have little or no increase in the 

 blood urea but that some, particularly in the tertiary stage, have figures 

 considerably above the normal. Gorham and Meyers found the cholesterol 

 content of the blood about the same in syphilitics as in their normal 

 controls. In tuberculosis and typhoid fever there was a considerable 

 increase. 



Scarlet Fever. In scarlet fever Pipping found that the nitrogen 

 excretion was abnormally high in most of his cases but he was able to 

 bring one patient into nitrogen balance on a very liberal diet. Loening 

 observed that the nitrogen excretion remained high for 8 to 10 days after 

 the drop in temperature but did not believe that this was due to kidney 

 insufficiency in spite of the fact that many of his patients suffered from 

 nephritis. Tileston and Comfort, in four mild cases of this disease, were 

 not able to establish a retention of non-protein nitrogen in the blood, but 



