174 Temperature Disturbances. 



tially an increase of oxidation (increased consumption of oxygen). 

 As a result of this heat production is increased. 



There is, however, a well defined type of fever in which there is 

 no recognizable increase of heat production (Krehl), the febrile condition 

 resulting solely from diminution of heat dissipation. 



This increase exists at the time of the initial stage and is marked 

 during the chill, the muscular contractions in this phenomenon add- 

 ing to the heat production. Heat dissipation is also increased in 

 fever; otherwise the temperature would continue to progressively 

 rise throughout the attack (Krehl). Dissipation is, however, less 

 than production. (It is only in the period of invasion that heat 

 dissipation is with any uniformity diminished, in the chill, by the 

 constriction of the cutaneous vessels.) 



The increased albumen destruction by oxidation is shown by 

 the increased nitrogenous output in the urine, the increased elimina- 

 tion of carbonic acid and the lessened oxygen elimination. Coinci- 

 dently there is a retention of water ; Senator has shown that of the 

 ingested fluids, only one-third or less appears in the urine, a cir- 

 cumstance which cannot be explained by the amount lost by evapor- 

 ation from the skin (v. Leyden). The water may be supposed to 

 be used to keep in solution the large accumulation of products of 

 the increased metabolism in the tissues ; this idea receives corrobora- 

 tion in the fact that after the crisis when the retained substances are 

 being eliminated there occurs a polyuria without increase of inges- 

 tion of water (Blumenthal). A large part of the nitrogen produced 

 by the increased albumen destruction must come from the blood, the 

 disintegration of the latter being the cause of the high proportion 

 of potassium and urobilin met in the urine (Blumenthal). The uric 

 acid excretion is also increased, from which may be inferred a 

 marked destrtiction of the nucleo-albumens (Blumenthal). 



Probably not all of the products of tissue disintegration are 

 eliminated from the system or consumed ; the urine does not con- 

 tain everything which underwent disintegration in the organism. 

 Probably during the fever some of its products are employed for 

 tissue reconstruction or in the formation of antitoxines. The 

 chlorides, phosphoric acid and sodium are found in the urine in 

 smaller proportion than normally. AA'ith the critical decline of the 

 fever, the tissue destruction ceases and the organism rapidly re- 

 stores its nitrogen-containing structures, the nitrogenovis excretion 

 falling below its intake and a distinct increase in body weight 

 ensuing (Blumenthal). Only in cases in which, because of re- 



