80 



METABOLISM IN SEVERE DIABETES. 



prior to the time of observation his diet had been unfortunate. The case illus- 

 trates the unreliability of prognosis without repeated observations upon the 

 same patient. 



Physical examination. Greatest weight without clothing, 90.7 kilos.; 

 July 1908, 85.3 kilos.; February 23, 1910, 64.5 kilos. Height, 170 cm. Tour 

 de taille, 76 cm. Pupils equal and reacted to light. Knee-jerks normal. No 

 edema of extremities. A few small left axillary glands. No acetone odor to 

 breath. One-third of the teeth missing. Lungs and heart normal. Pulse-rate, 

 80. Blood-pressure, 90 (two estimations, Riva Rocci). Abdomen, nothing 

 abnormal felt. 



Urine data. The urinary record for the period of observation is given in 

 table 99. The reaction was acid throughout, except March 14-16, 1910, when 

 it was alkaline. There were occasional slight traces of albumen. The quan- 

 tity of sugar in the urine on February 27-28, 1910, amounted to 209 grams in 

 24 hours, and the ammonia to 1.9 grams. Under strict dieting, sugar disap- 

 peared from the urine after 12 days and the urine was sugar-free on December 

 1, 1910, the weight having risen to 71 kilos. No sodium bicarbonate was 

 given the patient, except 15 grains on both March 14 and March 15. On April 

 26, 1912, the quantity of sugar reached 39 grams in 24 hours, and there was a 

 trace of diacetic acid. The patient reported having successfully withstood an 

 attack of pleurisy, and that the 6.8 kilos, of weight lost during that illness had 

 been regained. 



EXPERIMENTS WITH CASE X. 



With this subject 3 calorimeter experiments were made, in all of which the 

 chair calorimeter was used. The third experiment was preceded by a respira- 

 tion experiment. No food was taken in any of the experiments, and a fast of at 

 least 12 hours preceded them. A comparison of the results obtained in the 

 calorimeter experiments is given in table 107. The vital statistics of the sub- 

 ject were as follows: 



Date of birth, October 1875; height, 170 cm.; range in body-weight with- 

 out clothing during the experiments, 62.3 to 64.6 kilos. 



Table 100. Measurements of metabolism Calorimeter experiment No. XI. 



1 Carbon dioxide eliminated per kilogram per minute, 3.53 c.c; oxygen absorbed per kilogram per minute, 4.80 c.c. 



Calorimeter Experiment No. XI. 



Date, February 28, 1910. Body-weight without clothing, 62.3 kilos. 



The subject came to the laboratory without breakfast at 8 h 10 m a. m. 

 and entered the chair calorimeter at 8 h 41 m a. m. The experiment began at 

 10 h 10 m a. m., and continued for three 1-hour periods, ending at l h 10 m p. m. 

 Records of the pulse and respiration rates were obtained by means of the steth- 

 oscope and pneumograph, while body-temperature records were secured with 



