128 



METABOLISM IN SEVERE DIABETES. 



Urine analyses. To study the degree of acidosis, the subject made a care- 

 ful urine analysis on three days of the study. The results of these analyses are 

 reported in table 136. Unfortunately, the value for /3-oxybutyric acid on Sep- 

 tember 7-8 is questionable and is therefore not included. It will be seen that 

 there was a measurable amount of acetone and /3-oxybutyric acid appearing in 

 the urine; there was also an increase in the amount of ammonia which rose 

 on the last day to about 4 grams with approximately 18 per cent of the 

 total nitrogen in the form of ammonia-nitrogen. These commonly accepted 

 indices of an acidosis are particularly well shown in this experiment. 



Composition of the alveolar air. This subject had been particularly 

 interested in studying the composition of alveolar air and so made a 

 number of observations upon himself prior to and during the experiment, the 

 results of which are given in table 137. Of special interest is the carbon- 

 dioxide tension, which falls below the normal immediately after the beginning 

 of the carbohydrate-free diet, the average on September 8 being some 7 mm. 

 below the normal. The oxygen consumption shows a corresponding increase. 



Table 137. Determinations made on alveolar air with H. L. H. 



'Subiect began the carbohvdrate-free diet after the noon meal of 



Sept. 5, 1911. He ate food at 12 h 20 m p.m. Sept. 6. 

 2 Probably after food. 



EXPERIMENTS WITH H. H. A. 



The important point observed in connection with the study with H. L. H., 

 namely, an increased metabolism incidental to the ingestion of a carbohydrate- 

 free diet, justified a second carefully-planned study on another subject. The 

 subject of this second study was placed in the New England Deaconess Hos- 

 pital, so that the diet was under rigid control throughout the entire period. 

 Being a medical student and a man of unusual intellectual keenness in the 

 problems involved, he cooperated most heartily with us in all these tests. 



A series of nine experiments was made with this subject, including a pre- 

 liminary experiment with a normal diet, five experiments with a carbohydrate- 

 free diet, one experiment during which oatmeal was ingested, one experiment 

 with cane sugar, and a final experiment following a normal diet. The vital 

 statistics of the subject were as follows: 



Date of birth, August 10, 1890; height, 164 cm.; range in body-weight 

 during experiments, 60.9 to 63.5 kilos. 



