18 



METABOLISM IN SEVERE DIABETES. 



control. August 4-5, 1910, the specific gravity was 1.024, with diacetic acid 

 present, 0.11 per cent of ammonia, 0.36 per cent of nitrogen, and 2.8 per cent of 

 sugar by copper reduction and 2 per cent by rotation. August 9-10, 1910, the 

 total amount of urine was 1625 c.c. with 5.64 grams of nitrogen and 64.3 grams 

 of sugar. August 10-11, 1910, the total amount of urine was 1380 c.c, with a 

 slight trace of albumen, and 3 per cent (41 grams) of sugar. Diacetic acid was 

 also present. The reaction was acid in all instances. The acidosis at this time 

 was far less than during most of the year 1909, and much of October and 

 November 1908. The decrease in sugar and in ammonia may bear a relation 

 to the development of active tuberculosis in the lungs. Case R is, however, a 

 more striking example of this feature. 



EXPERIMENTS WITH CASE A. 



In the previous publication, 16 calorimeter experiments were reported with 

 this subject. In all but one of these the chair calorimeter was used. The 

 only experiment with the subject reported here is a respiration experiment. 

 The vital statistics are as follows: 



Date of birth, May 2, 1860; height, 171 cm.; body-weight without cloth- 

 ing during experiment, 46.1 kilos. 



Respiration Experiment No. Al. 



Date, August 10, 1910. Body-weight without clothing, 46.1 kilos. 



The subject came to the laboratory the morning of the experiment, fasting, 

 and lay down upon the couch at 8 h 05 m a. m. The experiment began at 8 h 26 ra 

 a. m., continuing for three periods, 11 to 15 minutes in length, with intermis- 

 sions of 15 and 20 minutes. The experiment was without incident. The 

 results are given in table 5. 



Table 5. Results of respiration experiment No. Al. 



1 Carbon dioxide eliminated per kilogram per minute, 2.89 c.c.; oyxgen absorbed per kilogram per minute, 4.08 c.c. 



CASE B. 

 DESCRIPTION OF THE CASE. 



Female; born September 9, 1869; married; doing her own housework; first 

 recognized symptoms of diabetes mellitus at the age of 39, December 25, 

 1908; came under our observation September 1909; died in coma April 13, 

 1910. 



The earlier history of this case, with the results of experiments made with 

 her, has previously been published. 1 No further metabolism experiments 

 have been made with this subject. The patient gradually failed during the 

 spring of 1910. Her weight on leaving the hospital March 3, 1910, was 40.7 



1 Benedict and Joslin, loc. cit., p. 61. 



