GENUINE DIABETES MELLITUS 537 



I laid these tables before the congress in my communication. It will 

 readily be understood why I on the data of these experiments believed that 

 there was an essential increase in the production of calories in diabetes 

 mellitus. 



The production of calories per kg. per hr. is on the average in the diabetics, 1.34, in the 

 normal person, 1.345; the oxygen consumed is in the diabetic greater throughout. It is 

 on the average, 4.59, in the normal person, 4.24. 



I shall speak later as to the cause of the greater oxygen consumption in 

 diabetics. 



The carbonic acid production is on the average in diabetics 3.26, in the normal person, 

 3-65. 



Hence the production of carbonic acid is somewhat less in the diabetics. 



The respiratory quotient is very low throughout in the diabetics, cor- 

 responding to the circumstance that all the cases investigated were moder- 

 ately severe cases. Also the person C may be counted with the moderately 

 severe cases. 



The question that I asked myself at the reworking-up of the experiments 

 was the following: Do there exist severe cases of diabetes mellitus that in 

 spite of the copious elimination of sugar show no increase in heat production 

 during fasting? As there were only a relatively few experiments at my 

 disposal for the solution of this, conclusions as to the question were merely 

 tentative. The diet which the persons tested received on the days be- 

 fore the experiments were mixed. It contained, however, neither abun- 

 dant carbohydrate or protein. As all experiments began fourteen hours after 

 the latest ingestion of food and lasted six hours, so that the experiment lasted 

 for the fourteenth to twentieth hours after the latest ingestion of food, the 

 quotient D :N observed must be regarded as high. Only in person C did the 

 quotient D : N fall almost to o during the period of experimentation. In the 

 first persons under experimentation the ammonia value was also raised very 

 high. In person A the /3-oxybutyric acid in the urine was also estimated 

 and found in not inappreciable quantity. I have not included these figures 

 in the tables and refer to the detailed works on Benedict and Joslin. In such 

 severe cases, as persons A and B are, one must expect under conditions of 

 experimentation that there would have been an appreciable result, if the 

 heat production in severe diabetes is really increased. It was not the case, 

 however. We have already seen previously that the chemical observations 

 allow this result to be anticipated. 



On the study of the extensive and carefully detailed experimental material 

 contributed later by Benedict and Joslin I have arrived at the conviction 

 that an increase of heat production in diabetes mellitus cannot be inferred 

 also from this material. The explanation of the deviating conclusions of 

 Benedict and Joslin is to be sought, I think, in the fact that they did not take 



