28 



METABOLISM IN SEVERE DIABETES. 



strawberries, oranges, and grapefruit, and even used it on bananas, apples, and 

 cantaloupe. A physical examination July 5, 1910, showed the blood-pressure 

 to be 120; pulse-rate, 96; heart 5 cm. to the right of the median line, the left 

 border lying within the mammillary line, with systolic murmur at the left 

 border of the sternum and at the base. The liver was 2 to 3 fingers' breadth 

 below the costal margin. The spleen was not palpated. On November 28, 

 1910, the weight was 82.6 kilos., the pulse-rate 84, and the condition good, 

 except for pain in the vicinity of the sixth rib near the mammillary line. This 

 pain resulted from a fall and a possible fracture of the rib. On December 16, 

 1910, he was considerably shaken up in a railroad accident, besides being- 

 exposed to a nervous strain in escaping from an overturned car. It will be 

 seen from table 18, which gives the urinary record, that the quantity of sugar 

 in the urine increased at this time. In May 1911 he took a 5 weeks' vacation 

 trip to Europe. A physical examination gave the same results as previously. 

 On October 3, 1911, the patient had symptoms suggesting an attack of biliary 

 colic. These subsided gradually, however, and after a week's rest recovery 

 was complete. On December 28, 1911, his condition was excellent. An 

 examination showed that no murmur could be heard in the heart. The blood- 

 pressure was 125 and the pulse-rate 88. There was a slight resistance, but no 

 tenderness in the region of the gall-bladder. In the observations made of the 

 urine an acid reaction was shown throughout ; there was a slight trace of albu- 

 men on January 1, 1911, and a very slight trace on May 15, October 2, and 

 December 23. 



Table 18. Clinical chart Case M. 



NH3 N 



'/3-oxybutyricacid, 1.9 gms.; ammonia, 1.3 gms.; . =6.9 per cent.; sugar by fermentation, 36 gms. 



'Per cent. 



EXPERIMENTS WITH CASE M. 



Three calorimeter experiments with this subject were reported in the pre- 

 vious publication. In two of the experiments the bed calorimeter was used: 

 the chair calorimeter was used in the third. Two additional experiments are 

 reported here, one with the bed calorimeter and one with the respiration appa- 

 ratus. The vital statistics are as follows: 



-'- W Date of birth, January 23, 1853; height, 172 cm.; range in body-weight 

 without clothing during experiments, 81.7 to 82.9 kilos. 



Respiration Experiment No. Ml. 



Date, August 17, 1910. Body-weight without clothing, 81.7 kilos. 

 This experiment, which was made with the respiration apparatus and with 

 the subject fasting, included four separate periods of 10 to 11 minutes each, 



