DISCUSSION OF RESULTS AND GENERAL CONCLUSIONS. 119 



large number of kymograph records obtained in connection with this research 

 makes it evident that the normal individuals on the whole were considerably 

 more restless than were the diabetic individuals. The diabetic patients were 

 for the most part sick, weak, and disinclined to any extraneous muscular move- 

 ments and remained lying quietly in bed. It may therefore be safely stated 

 that the influence of extraneous muscular activity was infinitely less with the 

 diabetics than with the normal individuals. Hence one would expect to find 

 a higher metabolism with the normal individuals than with the diabetics, as 

 the influence of even minor muscular activity upon the metabolism is surpris- 

 ing a fact only appreciated by one who is constantly working in the labora- 

 tory, measuring the metabolism of a subject and comparing the simultaneous 

 records of muscular activity. This relationship between minor muscular activ- 

 ity and metabolism has been observed in this laboratory, 1 even with infants. 



In an experiment designed to answer a criticism as to the soundness of 

 using kymograph records to indicate muscular rest, it was found by actual test 

 that the kymographs are so sensitive that even a minute muscular tremor, 

 such as the movement incidental to slight shivering, is instantly transmitted 

 to the tambour and recorded on the kymograph. 



DETAILED COMPARISON OF NORMALS AND DIABETICS. 



From our list of normal subjects it is possible to select for purposes of com- 

 parison one or more to compare with each individual diabetic, with the single 

 exception of Case N. As he was a boy, we had no normal subject who was 

 comparable in age, weight, and height; consequently, Case N is not included in 

 the averages. On one occasion Case A weighed 51.6 kilos., and later weighed 

 46.1 kilos.; a fall in body-weight of 7 kilos, was likewise noticed with Case C. 

 Accordingly, in order to make the analogy as complete as possible, we have 

 compared the diabetics with different normals at the stages of the disease when 

 there was a change in their body-weights. All these comparisons have been 

 brought together in table 131, in which are grouped first, the cases of severe 

 diabetes and the normal individuals with whom they are compared, and second, 

 the moderately severe and light cases, of which only three were studied. Of 

 particular interest are the comparisons between the cases of severe diabetes 

 and the normal individuals. 



The carbon-dioxide production per kilogram of body-weight with all of the 

 cases of severe diabetes was 3.31 c.c. per kilogram per minute, and with normal 

 individuals 3.13 c.c. per kilogram per minute. This increase, which is approxi- 

 mately but 6 per cent, is fully in line with that noted in the earlier publication, 

 and is obviously explained in part by the fact that the metabolism of the diabe- 

 tics was essentially a protein-fat metabolism, while that of the normal subjects 

 was unquestionably a protein-fat and glycogen or carbohydrate metabolism. 



As pointed out earlier, the difference between the carbon-dioxide produc- 

 tion on these two groups of individuals does not measure by any means the 

 difference in the actual metabolism. This is best shown by a comparison of the 



l Benedict and Talbot, Am. Journ. Diseases of Children, 1912, 3, p. 1. 



