66 METABOLISM IN SEVERE DIABETES. 



CASE U. 

 DESCRIPTION OF THE CASE. 



Female; born November 16, 1873; single; teacher; onset of diabetes, April 

 1909; sugar found in the urine August 1, 1909; first came under our observa- 

 tion April 18, 1910; died in coma August 11, 1911. 



Family history. No history of diabetes in family. Father, mother, and 

 two brothers well; one brother has arthritis deformans. 



Past history. Healthy ; scarlet fever three times, measles, mumps, whoop- 

 ing cough. Pneumonia at 14. Catamenia normal. Overwork and worry, 

 especially because of the brother's illness. 



General history of case. In April 1909 there were loss of weight and poly- 

 dipsia. In May 1909, polyuria, furuncles, and weariness appeared. Follow- 

 ing the discovery of sugar in the urine, thirst and nervousness nearly disap- 

 peared and the strength improved; nevertheless the patient had polyphagia. 

 The course of the disease is shown in table 77. Notwithstanding the severity 

 of the disease, the patient taught daily until May 1911. There was a gradual 

 loss in strength, as well as in weight, and she died in coma August 11, 1911. 



Physical examination. Greatest weight, summer of 1908, 53.1 kilos.; 

 April 1909, 49.9 kilos. ; May 1909, 45.4 kilos. ; August 1909, 41.7 kilos. ; April 18, 

 1910, 39.7 kilos. Height, 160 cm. Pupils equal and reacted to light. Knee- 

 jerks normal. Bilateral submaxillary glands. Emaciated. Tongue and teeth 

 normal. Heart just within mammillary line, systolic at the apex. Pulse- 

 rate, 112. Blood-pressure, 100. Lungs normal. Abdomen, right movable 

 kidney but otherwise normal. No edema of lower extremities. 



Urine data. The quantity of urine August 1, 1909, was 5,750 c.c; spe- 

 cific gravity 1.040. The reaction of the urine was acid throughout the period of 

 observation. The acidosis was marked from the very first, but decreased sub- 

 sequently with the use of sodium bicarbonate. The greatest quantity of 

 ammonia was 5.2 grams, April 22, 1911. On March 11, 1911, the urinary sedi- 

 ment contained numerous fine and coarse granular casts. The quantity of 

 sugar in the urine when the patient first came under observation amounted to 

 7.2 per cent in a single specimen, and to 6.2 per cent (132 grams) during the 24 

 hours of April 19-20, 1911. This steadily decreased, but the patient never 

 became sugar-free. Albumen never exceeded a slight trace. 



EXPERIMENTS WITH CASE U. 



With this subject three bed calorimeter experiments were made and nine 

 respiration experiments. A number of these were made in series. Series I 

 included a calorimeter experiment (U5) in which the subject fasted, and a 

 respiration experiment (U6). In this latter experiment the subject fasted the 

 first two periods, then took food. Series II, which included five experiments, 

 began with a respiration experiment (U8), which was followed by an oatmeal 

 breakfast; an experiment was then made with the bed calorimeter (U9), which 

 was in turn succeeded by a second respiration experiment (U10). The sub- 

 ject spent the night in the bed calorimeter, metabolism measurements being 

 made during the latter part of the night (Ull). In the morning of the next 

 day, a third respiration experiment (U12) was made after a beefsteak break- 

 fast, completing the series. A comparison of the data obtained in the calo- 

 rimeter experiments is given in table 92. The vital statistics for this subject 

 are as follows: 



