118 METABOLISM IN SEVERE DIABETES. 



criticism was more of a theoretical than a practical nature is demonstrated by 

 the fact that the actual increase in metabolism noted in the new observations 

 is somewhat higher than that noted when the earlier tests were made. 



The measurements of the metabolism of Case I were stated in the first 

 report to be unsatisfactory for the reason that the subject was high-strung and 

 nervous, and consequently by no means an ideal subject. Fortunately, some 

 months later it was possible to secure this subject for another experiment. 

 At this time he was weak, emaciated, and disinclined to muscular activit}'. 

 During the experimental period he lay in the bed calorimeter extremely quiet, 

 and prior to the experiment exhibited none of the nervousness and excitement 

 which he had shown before the two experiments of the year previous. These 

 later results may accordingly be taken as a measurement of the metabolism 

 of a diabetic with severe acidosis, but with a minimum amount of extraneous 

 muscular activity. While, therefore, in the earlier experiments with the chair 

 calorimeter he did not appear to be an ideal subject, in his last experiment with 

 the bed calorimeter no criticism could be raised with regard to the conduct of 

 the experiment or to the subject himself, so that the influence of extraneous 

 muscular activity may be disregarded. The results of the last experiment with 

 the subject abundantly confirm those of the first two in showing a marked 

 increase in the total metabolism. 



SELECTION OF CONTROLS. 



In this comparison of normal individuals with diabetics care has been taken 

 to select controls that approximate as nearly as possible the exact body- weight 

 and height of the diabetic subjects to which they are to be compared. This has 

 been difficult in certain instances, owing to the fact that frequently the dia- 

 betics were much emaciated and it was difficult to find a person of a correspond- 

 ing height and weight. The evidence with regard to the disproportion between 

 skin area and body-weight, first suggested by Magnus-Levy and considered by 

 us in the earlier publication, has been further amplified by observations during 

 an experiment with prolonged inanition. Although during this experiment 

 the subject lost in weight 15 kilograms, there was no loosening of the skin. 

 The skin contracted as the flesh disappeared and hence there was no evidence 

 that there was a disproportion between the body-surface and the body-weight. 



A further precaution was taken to select normal subjects who were not on 

 the laboratory staff, except when it was necessary in order to obtain subjects 

 that were comparable in size and weight. Of the 20 or more subjects used for 

 comparison, more than half did not belong to the laboratory staff; hence, on 

 the whole, the normal subjects were more often untrained than were the 

 diabetics with most of whom experiments were frequently made. 



EVIDENCE OF THE KYMOGRAPH RECORDS. 



The use of one or more tube pneumographs about the thighs or chest for a 

 record of the degree of muscular activity of the subject has proved a most suc- 

 cessful venture, but the expense incidental to reproducing kymograph records 

 makes it impossible to present them here. A most careful scrutiny of the 



