CONTROL OF BOD? TEMPEBATUB1 wi' rivu: 72-°. 



more readily brings down the temperature :im<1 keeps ii down for a Longer 

 time than during the firsl or Becond week. The mechanism for heal 

 is also tic ranged in fever, which explains the rise in temperature thai 

 likely to follow the performance of even moderate muscular i • or 



the taking of too hearty a meal in tuberculous and convalescent typhoid 

 patients. 



Changes in the Body During Fever 



In seeking Eor the fans.' of fever which is evidently of an obscure 

 nature, it is necessary to colled all the information we can regarding 

 iln- in. 'tain. lie changes thai are then occurring in the animal body. A 

 few of the most significan1 facts thai have so far been collected may 

 be mentioned here. Some of the most important concern the dis- 

 turbance in nitrogenous equilibrium cause.] by th< nsiderable loss of 



nitrogen which takes place in fever patients when they are fed on 

 the usual hospital did prescribed for such cases. This loss of nitro- 

 gen is no doubt the result of the partial starvation in which the pa- 

 tienl is kept: for it has Keen shown by Shaffer and Coleman 88 that 

 patients with typhoid fever may be maintained in nitrogenous equi- 

 librium by feeding them with relatively largo am. units of carbohy- 

 drate, which acts by protecting the protein of the body from disintegra- 

 tion (see page 571). Even with a diel excessively rich in carbohydi 

 that no more than covers the calorie requirements of the patient, nitrog- 

 enous equilibrium has also been attained. The protein minimum to 

 which fever patients .-an be reduced is nevertheless considerably higher 

 than the minimum in normal individuals. 



From the above results as a whole, it is probably safe to conclude that 

 there is a specific destruction of proU in Lr«>in>_r on in the body during fever. 



Further evident £ such a destruction is furnished by the presence in 



the urine of excessive amounts of creatinin, of purine bases, and. it is 

 said, of incompletely hydrolyzed proteins, such as the albumoses pro- 

 teoses.) Moreover, when the fever suddenly terminates in crisis, there 

 Lb a marked increase in the excretion of urea (the epicritical area in- 

 Be), which indicates that an extensive deamination of protein build- 

 ing ston.s amino acids is occurring. The so-called "diazo react: 

 obtained in the urine during the fever is also believed to depend on the 

 present f abnormal protein-disintegration produ 



As t.» the specific cause of the increased protein disintegration, little 

 is known. Several factors may operate: 1 the partial starvation 

 patient, entailing an b tkdown of protein 10 meet the caloric 



requirements; 2 the high temperature, which in itself may stimul 

 increased protein metabolism, for it has been shown that, when normal 



