METABOLISM IN FEVER AND CERTAIN INFECTIONS 149 



Yeoder and Johnston obtained figures for non-protein nitrogen and crea- 

 tinin which were slightly above normal. 



Oppenheimer and Reiss demonstrated a considerable retention of 

 sodium chlorid in scarlet fever. In one case with 6 gm. in the food there 

 was only half a gram in the urine. During this period of positive salt 

 balance there was an increase in body weight and a diminution in the 

 concentration of protein in the blood, indicating a retention of water in 

 the blood. When the fever disappeared the weight dropped and the con- 

 centration of protein in the blood rose to normal. Magnus-Alsleben made 

 some interesting studies on the acid excretion in scarlet fever, finding 

 large amounts of organic acid in the urine. " Mohr, who has studied the 

 C/N ratio in scarlet, and other fevers found the ratios, on the whole, 

 were normal. 



Acute Rheumatic Fever. Comparatively few studies have been made 

 of the metabolism in acute rheumatic fever. Rolland was able to attain 

 nitrogen balance in one patient when she administered daily in the food 

 11.5 grams of nitrogen and 3,400 calories (56 calories per kilogram). 

 This was undoubtedly greatly in excess of the patient's heat production. 

 Kocher gave a 16-year-old patient weighing 35 kilograms 2,600 calories 

 per day (77 calories per kilogram) with 0.96 to 1.12 grams of nitrogen in 

 order to determine the nitrogen minimum. The nitrogen output in the 

 urine remained over 11 grams a day until ^the fever was ended, when a 

 normal figure of 3.2 grams was reached. The creatinin was 1.6 to 1.8 

 grams and the uric acid 0.8 to 1.3 grams a day. These experiments of 

 Rolland and Kocher show exactly the same phenomena as in typhoid fever 

 and point towards a toxic destruction of protein. Frothingham, in a series 

 of rheumatic fever patients, found a few with some evidences of acidosis 

 and a few with a low excretion of phenolsulphonephthalein. Freund and 

 Marchand, in nine cases, obtained an average blood glucose of 116 mgm. 

 per 100 c.c. 



The first accurate calorimetric observations on the metabolism in fever 

 were made by Carpenter and Benedict (6) in the large Atwater-Rosa-Bene- 

 dict calorimeter in Middletown, Connecticut. While they were making ex- 

 periments on normal men a number of their subjects developed fever with 

 symptoms of malaise and nausea. The cause of the disturbance was never 

 absolutely certain, but it seemed to be a form of poisoning from mercury 

 used to seal the air valves, and a removal of this mercury put an end to 

 the febrile attacks. The same subjects were observed later without fever, 

 and it was evident that during the periods of high temperature there was a 

 distinct increase in the oxygen consumption, and carbon dioxid and water 

 elimination. Since the experiments were made during the period of 

 rising temperature the increase in heat production was more marked than 

 the increase in elimination. 



It is interesting to compare the metabolism in toxic fevers with that 



