NUTRITION LABORATORY. 225 



During the observations a radical change was made in treatment. Prior 

 to 1914 the patients were overfed with a low-carbohydrate and high-protein 

 fat diet. In June 1914 fasting and undernutrition were introduced. The 

 change in the method of treatment so profoundly affected the metabolism 

 of the diabetics as to necessitate the separation of observations into two 

 groups. Before 1914 the post-absorptive metabolism of the 113 patients 

 averaged 12 per cent above normal, but with the low diet after 1914 it was 

 11 per cent below normal, with a range for all degrees of severity from 32 

 per cent above to 40 per cent below standard. This difference in the metab- 

 olism before and after 1914 was especially apparent with the severe cases. 

 The change was reflected in the pulse-rate, which averaged 73 beats before 

 and 65 beats after 1914. 



The acidosis decreased with the change in dietetic treatment, the number of 

 experimental days on which it was present falling from 85 per cent to 67 

 per cent with the whole group and from 40 per cent to 5 per cent with the 

 severe diabetics. A study of the relation between acidosis and metabolism 

 led to the conclusion that acidosis increases the metabolism. The nitrogen 

 excretion per kilogram of body-weight followed the general trend, in that it 

 was approximately one-third less following the change in diet in 1914. The 

 nitrogen metabolism did not adequately explain variations in the basal 

 metabolism. 



Age was found to have a definite influence upon the metabolism of the 

 diabetic. Patients between 51 and 70 years had an approximately normal 

 metabolism, but with individuals between 21 and 50 years of age the metab- 

 olism averaged 17 per cent above standard in the early period and 10 per 

 cent below in the later observations. 



The respiratory quotient in diabetes was shown to bear a definite relation 

 to the metabohsm, being low when the metabohsm was high and higher 

 when the metabolism was low, with a general tendency to rise as the metab- 

 olism fell. The average quotient before June 1914 was 0.73 as compared 

 with an energy metabolism for the same cases of 13 per cent above standard, 

 while after June 1914 it was 0.77 as compared with 10 per cent below standard 

 for the metabohsm. Both extremely low and extremely high quotients were 

 found, the former being due to the ingestion of much protein and fat with 

 little carbohydrate, with some evidence to indicate that the high quotients 

 were due to lack of available fat, necessitating unusual katabolism of body 

 protein or even the transformation of carbohydrate into fat. 



The post-absorptive observations upon diabetics were supplemented by 

 similar observations in 1916 upon a healthy individual who underwent for 

 20 days the treatment then employed for diabetes. The results showed a 

 loss in weight, development of acidosis, decrease in blood sugar, and constant 

 basal metabohsm. 



A great many of the experiments after food were made with levulosc, there 

 being 51 experiments in all with this substance. While the quantities in- 

 gested were in the main well utilized, the urines remained sugar-free with the 

 severe cases in but 9 experiments. After levulose the metabohsm rose on the 

 average 17 per cent, this increase being shghtly greater than that found with 

 normal individuals previously studied by the Laboratory and continuing at 

 a higher level for a longer period of time. The increase was more prominent 

 with the severe cases. The average quotient for the group in the second 



