104 METABOLISM IN SEVERE DIABETES. 



desirable to control the clinical experience of Cantani, Naunyn, von Noorden, 

 and others by experiments upon diabetics with a low-protein and with a high- 

 protein intake, and this we hope at some time to do. 



It is important in this connection to note that the protein metabolism of 

 these diabetics was not abnormally great, and hence we have not here to deal 

 with anything approximating an excessive specific dynamic action due to the 

 disintegration of body protein as a result of the disease. 



Gaseous Metabolism, 

 carbon dioxide excretion in diabetes. 



The earliest factor in the gaseous metabolism of diabetic patients to be 

 quantitatively measured was the carbon-dioxide production, and this was 

 determined by the Pettenkofer-Voit chamber with great accuracy. The same 

 type of apparatus was used even as late as 1910 by Dubois and Veeder under 

 the direction of Brugsch. As was pointed out in our earlier report, the rela- 

 tionship between the carbon-dioxide excretion and the heat production was 

 so accurately established by our experiments with the calorimeters that the 

 carbon-dioxide measurement acquired thereby a new significance. 



In discussing the carbon-dioxide production of diabetics in this report, it 

 seems desirable to present again the observations previously reported, 1 but in 

 this instance emphasizing the average carbon-dioxide production not of all 

 cases, but only of such as were classified as severe. These data are given in 

 table 119, in which the carbon-dioxide production of diabetics in experiments 

 without food is expressed as cubic centimeters per kilogram of body-weight per 

 minute. In the earlier investigations, the chair calorimeter, the bed calorim- 

 eter, and the respiration apparatus were used about equally, the variations 

 in the carbon-dioxide production as measured on these different forms of 

 apparatus being shown in the table. As was previously pointed out, the 

 carbon-dioxide production as determined with the bed calorimeter and the 

 respiration apparatus was essentially the same, not only with the single indi- 

 viduals but with the group of individuals. On the other hand, with the chair 

 calorimeter there was a considerable increase in the carbon-dioxide production 

 incidental to the increase in muscular tonus because the subjects were sitting 

 up and showed greater activity in general when inside the chair calorimeter. 

 The values for the moderately severe and light cases of diabetes, although 

 included in table 119, do not need special discussion. The particularly low 

 value found for Case M is obviously influenced by the great body-weight of 

 this subject, who was distinctly fat. On the average, therefore, with severe 

 diabetics, the carbon-dioxide excretion per kilogram of body-weight amounted 

 to 3.53 c.c. per minute of carbon-dioxide with the chair calorimeter, 3.15 c.c. 

 with the bed calorimeter, and 3.18 c.c. with the respiration apparatus. The 

 increase of approximately 10 per cent in metabolism noted in experiments with 

 the chair calorimeter over that in experiments with the bed calorimeter and 



'Benedict and Joslin, loc. cit., p. 176. 



