DISCUSSION OF RESULTS AND GENERAL CONCLUSIONS. 87 



increased metabolism previously noted and further substantiated by the evi- 

 dence set forth in this report. Yet in this discussion of the pulse-rate it should 

 be stated that it is questionable whether sufficient information with regard to 

 normal pulse-rate has accumulated to indicate that a variation above normal 

 of 15 per cent could be recognized. While the metabolism may be 15 per cent 

 above normal and be accurately measured, since normal metabolism is fairly 

 well established, a 15 per cent increase in pulse-rate could not be so easily 

 identified. The intimate relationship between pulse-rate and metabolism is 

 increasingly evident in practically every new publication on metabolism and 

 shows that to-day the pulse-rate is taking on a new significance; it is not at all 

 impossible that the degree of acidosis and the degree of metabolism may be at 

 least approximately estimated in diabetics by a careful examination of the 

 pulse-rate. In this connection, a reference to the later discussion on the rela- 

 tionship between acidosis and metabolism will be of interest. (See page 123.) 

 While an increased pulse-rate is invariably accompanied by an increased 

 metabolism, it is by no means to be inferred that the increased metabolism is 

 due exclusively to the work of the heart. In fact, from what is known of the 

 work of the heart, it can be seen that probably but a very small proportion 

 of the total increase can be properly ascribed to the actual muscular action of 

 the heart itself, but that the increased pulse-rate is an excellent index of gen- 

 eral tonus is highly probable. Unquestionably, during increased metabolism 

 and increased pulse-rate, there is some tendency toward an increased respira- 

 tion rate, but here again it is highly improbable that the muscular action 

 involved in raising the chest-wall can in any considerable proportion account 

 for the total increase in metabolism. On the other hand, both the increased 

 muscular activity of the heart and the increased work of the respiratory mus- 

 cles unquestionably contribute some small quota to the total increase in metab- 

 olism. We commend to the attention of the physician the importance of the 

 pulse-rate in diabetes and particularly the value of changes in the pulse-rate in 

 the same patient during the progress of the disease. We likewise commend to 

 all experimenters the practice first established by Prout 1 of reporting the 

 pulse-rate with the chemical data of each experiment. 



Body -Temperature. 



In a research of this kind, measurements of body-temperature have two 

 purposes. First, to learn whether the temperature measurements are within 

 normal limits and, second, for use in computing the heat production. The 

 variations in body-temperature necessitate proper corrections for heat stored 

 when the body-temperature rises, or for heat given off, and thus not produced, 

 as the body-temperature falls. An ideal experiment, therefore, would call for 

 continuous measurements of body-temperature, particularly at the beginning 

 and end of each experimental period. In this laboratory and in the laboratory 

 of Wesleyan University, Middletown, Connecticut, much attention has been 

 paid in the last ten years to such measurements. To obtain the most accurate 



1 Prout, Ann. Philos., 1813, 2, p. 328. 



