30 ANALYSIS OF DISTURBANCES OF METABOLISM 



and MYXEDEMA (or sporadic cretinism) make it advisable to include these 



d.isG9-SGS here 



They are the only ones in which a diminution of the normal oxidation 

 has been proven with certainty to be intimately connected with disease. The 

 values which Magnus-Levy ^ obtained in a case of sporadic cretinism (for 0^ 

 intake 2.8 to 3.0 c.c, for CO^ excretion 2.4 to 2.5 c.c, per kilogram and 

 per minute) are near the lowest normal limits, and when taken in connection 

 with the clinical symptoms (low temperature, diminished formation of sweat, 

 inactivity of the muscles) the few analyses of metabolism which have been 

 made justify the conclusion that in this instance a diminution of metabolism 

 was actually present, and was due to the nature of the disease. 



In no other diseases in which up to the present time the interchange of 

 gases has been determined is the explanation of the results obtained so simple 

 and clear as it is in Graves' disease and in myxedema. Nevertheless, the 

 figures obtained have considerably modified the prevailing views regarding 

 the intensity of the processes of combustion in special diseases, and by this 

 means have broadened our insight into their pathogenesis, and have furnished 

 us much help regarding their treatment. 



For a long time it was supposed that in fever the processes of oxidation 

 were increased. Nothing was more obvious than to connect the higher tem- 

 perature of the body with an increased use of carbon-containing material in 

 the body. 



Eegarding the degree of the increase of oxidation in the fever of human 

 beings experimental investigations in animals could only give us imperfect 

 standards (May^). Researches which Kraus ^ carried out in febrile human 

 beings have, however, shown that fever is possible without decided increase 

 of the oxidation processes (measured according to Zuntz's method which shows 

 the relation of the factors of metabolism). This is particularly true of such 

 individuals as have had fever for a long time — ^those suffering from inanition 

 (Robin etBinet*). 



In acute infectious fevers, the O2 consumption amounts to scarcely more 

 than 20 per cent, above the normal. Previous to this, higher values have 

 frequently been obtained for the increase in oxidation, but this has been due 

 to accidental factors such as greater muscular activity owing to d}^spnea, 

 increased muscular tonus in the chill of fever, etc. 



The amount of increase in the interchange of gases, which Kraus and 

 Riethus ° have shown to be attributable to some febrile infections, is suffi- 



1 Magnus-Levy, Deutsche med. Wochenschr., 1896, p. 491. 



2 May, " Der StofFwechsel im Fieber," " Experimentalle Untersuehungen." Zeit- 

 schrift f. Biol., vol. xxx, p. 1. 



3 Kraus, " Ueber den respiratorischen Gasaustausch im Fieber." Zeitschr. f. klin. 

 Med., vol. xviii, p. 160. 



* Rohin et Binet, " Etudes eliniques sur le chgmisme respiratoire." Arch, ginir. de 

 mid., 1896, Juin et Octobre. 



6 Riethus, " Beobachtungen fiber den Gaswechsel kranker Menschen und den Einfluss 

 antipyretischer Medicamente auf denselben." Arch. f. exp. Path. u. Pharm., vol. xliv, 

 p. 239. 



