GENUINE DIABETES MELLITUS 53! 



Water-contents of the tissues of diabetics who had died in coma 

 per cent, lower than in normal individuals. 



The Respiratory Metabolism. The first experiments as to the caloric 

 exchange in diabetics are those of Pettenkofer and Volt. At the beginning, 

 these investigators misinterpreted their experiments. They overlooked on 

 the one hand the loss in oxygen that the diabetic suffers through the elimina- 

 tion of sugar rich in oxygen, and on the other hand they committed the error 

 of comparing the change in an emaciated diabetic weighing 54 kilograms 

 with a healthy individual weighing 71 kilograms. These objections have been 

 set forth especially by Leo; Pettenkofer and Voit later modified their opinion; 

 Fr. Voit again discussed the experiments in detail and came to the conclusion 

 that in severe diabetics the demand for calories is not increased. This 

 result is entirely in agreement of the long-protracted metabolism experiments 

 of Wientraud carried out at Naunyn's clinic. H. Leo, R. Stiive, Nehring and 

 Schmoll, and Magnus-Levy and Salomon have further instituted experiments 

 with the Zuntz-Geppert apparatus. They found that in severe diabetics 

 the oxygen requirements were increased. I shall not enter into the question 

 of the experiments of Livierato and of Robin and Binet, as the methods used 

 are not reliable. 



The interest in this question was reawakened through the demonstra- 

 tion that there was an increase in the production of calories in the dog 

 without a pancreas. Since this is true a series of experiments have been pub- 

 lished. Of especial interest is a great number of experiments that were 

 carried out in, Atwater-Benedict' 's respiration calorimeter. Finally I men- 

 tion a series of experiments carried out by Eugene DuBois and Borden 5. 

 Veeder with Pettenkofer's apparatus at Kraus's clinic, and finally experi- 

 ments with the Zuntz-Geppert apparatus by Leimdorfer. I shall discuss 

 later the experiments last mentioned. The experiments of Eugene DuBois 

 and Borden S. Veeder showed no increase in heat production. These authors 

 arrived at the same results as did Pettenkofer and Voit. 



A more exact exposition is demanded by the first-mentioned experi- 

 ments carried out in the respiration calorimeter. They were begun by 

 Benedict, Dr. Joslin and myself in collaboration, when I had gone to Boston 

 for the study of the respiration calorimeter. Our work in common concerned 

 itself with the first twelve experiments. I reported briefly concerning 

 these experiments at the Congress for Internal Medicine, 1909; and there, on 

 the ground of the comparison of the figures obtained with those obtained 

 with a normal subject, whom I had especially selected for comparison on 

 account of his low body weight, came to the conclusion that the resting- 

 exchange of the three diabetics investigated by us, and especially that of one 

 very severe case, was not essentially raised. Later Benedict and Joslin on 

 the ground of their more numerous experiments came to another assump- 

 tion. Since that time I have let the matter rest on account of other work. 



