26 



METABOLISM IN SEVERE DIABETES. 



Between February 24, 1910, and September 28, 1910, the patient remained 

 in excellent condition, and apparently free from sugar most of the time. 

 Although sugar was present in the urine upon April 19, 1911, it disappeared in 

 three days with the limitation of the carbohydrates to 25 grams. A physical 

 examination on this date showed that the blood-pressure (Riva-Rocci) was 100, 

 and that there was a slight systolic murmur at the apex of the heart which was 

 just within the mammillary line. The liver extended one finger's breadth below 

 the costal margin. These findings were confirmed on October 12, 1911. The 

 patient is now (May 1912) doing active work. 



The urinary record is given in table 15. The reaction of the urine was 

 acid throughout; there was no albumen present except a very slight trace on 

 April 21-22, 1911. The last sample of urine received from this subject was 

 on May 31, 1912; the reaction was acid, and there was neither albumen nor 

 sugar. On September 21-22, 1910, it will be seen that there were 20 grams of 

 sugar in the urine; on this day he did an unusual amount of physical work. 



Table 15. Clinical chart Case L. 



1 No sodium bicarbonate given. 



: From 7 h 30 m a.m. to 10 h 10 a.m., Sept. 27, 1910, volume of urine, 434 c.c; specific gravity, 1.016; nitrogen, 

 2.72 gms.; sugar, 3.7 gms. Another specimen of urine on Sept. 28, 1910, with a specific gravity of 1.022 gave 

 an acid reaction, showed no albumen or sugar, and only a slight trace of diacetic acid. 



EXPERIMENTS WITH CASE L. 



In the preceding publication five calorimeter experiments with this sub- 

 ject were reported. In four of these the chair calorimeter was used,the other 

 being with the bed calorimeter. Two additional experiments are reported 

 here, both respiration experiments. The vital statistics are as follows: 



Date of birth, October 18, 1886; height, 183 cm.; body-weight without 

 clothing during experiments, 66.5 kilos. 



Respiration Experiment No. LI. 



Date, September 26, 1910. Body-weight without clothing, 66.5 kilos. 



The subject came to the laboratory at 7 h 55 m a. m. fasting and imme- 

 diately lay down upon the couch after the pneumograph and stethoscope had 

 been adjusted. As the subject was quite confident that he would be able to 

 stay awake and keep his mouth firmly closed, surgeon's plaster was not used 

 over the mouth in the first period. As the results indicated that there might 

 be a leakage through the mouth, the plaster was used in the last two periods. 

 The experiment began at 9 h 12 m a. m., and continued for three periods of 13 to 

 15 minutes, with intermissions of 10 and 12 minutes, ending at 10 h 14 m a. m. 

 The subject moved his hands and arms occasionally, and changed his position 

 slightly, once putting his hand to his face. Although just previous to the 



