30 METABOLISM IN SEVERE DIABETES. 



Present illness. Early in June 1909 the boy began losing weight while 

 riding a new bicycle. During the first part of August, frequent micturition 

 developed and in the course of a few days he began to droop. 



Physical examination. Height, 146 cm.; greatest weight, 34.5 kilos.; 

 weight August 28, 1909, 29.6 kilos. Fairly well developed. Pupils equal and 

 reacted to light. Tongue and teeth normal. Lungs normal. Heart extended 

 2 cm. to right of median line and 9 cm. to left of median line (just external to 

 mammillary line). Sj^stolic murmur at apex. The liver extended 2 fingers' 

 breadth below the costal margin. Knee-j erks normal. No edema. 



Urine data. The greatest quantity of urine observed was at the onset, 

 when it reached 3500 c.c. The patient's urine contained 6.6 per cent of sugar 

 on August 28 and, on the following day, 162 grams were excreted. By the 

 restriction of the diet to 20 grams carbohydrate, the urine became sugar-free 

 on September 13 and this condition was maintained almost constantly until 

 November 22, 1909; he then evidently broke diet and the sugar in the urine 

 went up to 7 per cent (88 grams) . 



The sugar did not again disappear from the urine until December 15, 

 when the patient was at the hospital. It remained absent for the 4 days he 

 was there, returning promptly when he left the institution, and never disap- 

 peared save upon two days in January and one in February of the following 

 year. 



Albumen was either absent or present only in extremely small quantities; 

 during the last few months of life but a trace was present. 



The urine was invariably acid, save upon one day, December 18, 1909. 

 During the first period of observation, from August 1909 until April 1910, the 

 signs of acidosis were slight and represented at the most by only a moderate 

 reaction for diacetic acid. From that time on they increased, and the acidosis 

 was extreme in November 1910, when the patient was again in the hospital. 

 At this time the urinary record (table 21) shows 35 grams of /3-oxybutyric acid 

 in one day, and on the same day 4.2 grams of ammonia. 



Death finally occurred on February 16, 1911, after 3 days of coma. The 

 case therefore affords a most excellent example for a study of diabetes with and 

 without acidosis. During its duration of 19 months, the disease ran a course 

 free from complication, with the exception of the persistent ulceration of one 

 incisor tooth. 



EXPERIMENTS WITH CASE N. 



With this subject, eight calorimeter experiments were made, in all of which 

 the bed calorimeter was used. In seven experiments the subject entered the 

 apparatus without breakfast, after a 12 hours' fast. One experiment was 

 made following a breakfast of cooked oatmeal. In addition, one respiration 

 experiment was carried out with this subject. The data for the calorimeter 

 experiments are compared in table 33. The vital statistics were as follows: 



Date of birth, August 1, 1896; height, 146 cm. ; range in body-weight with- 

 out clothing during experiments, 30.5 to 32.5 kilos. 



Respiration Experiment No. Nl. 



Date, August 18, 1910. Body-weight without clothing, 32.5 kilos. 



In this experiment the respiratory exchange was determined by means of 

 the respiration apparatus, the subject lying on a couch. It is probable that 

 he took food previous to the experiment. The experiment began at 8 h 1 2 ra a.m., 

 covering one 10-minute period and ending at 8 h 22 m a. m. The subject was 



