GENUINE DIABETES MELLITUS 539 



Investigations with Zuntz-Geppart apparatus (p. 168): 



Individuals between 65 and 43.2 kg. Oz requirements per 



kg. per minute 4 . 08 c.c. 



Individuals between 66 and 88.3 kg 3.5 c.c. 



Investigations with the respiration calorimeter, during sleep (p. 168) : 



Individuals between 64.1 and 55 kg 4.04 c.c. 



Individuals between 66.1 and 84.7 kg 3 . 56 c.c. 



There does occur in severe diabetes a circumstance moreover that must 

 be considered especially. It is known that in the obese the fundamental 

 exchange is relatively low, as the obese person possesses little respiring proto- 

 plasm in relation with body weight. The severe diabetic is, however, always 

 strongly drained of water (as is shown in investigation on the water-con- 

 tents of the organs of those dying in coma) . Moreover, in severe diabetics 

 almost every -trace of fat has disappeared from the ordinary sites of fat-de- 

 position, as can be seen at almost every autopsy. If now in addition the 

 albuminous constituent suffers severe damage in the later stages, the mass of 

 respiring protoplasm in severe diabetes will be still greater in proportion 

 to body weight. I believe, therefore, that even if on calculation per kilo- 

 gram of body weight there is found in severe diabetics a slight increase of 

 heat production, this would not mean much. 



Already Lusk has pointed out the dissimilarity of the material compared 

 by Benedict and Joslin, and from this has drawn the conclusion that the in- 

 crease of heat production found by Benedict and Joslin is less high than these 

 authors suppose. From the calculations and discussions cited I must, however, 

 conclude that the demonstrations of an increase of heat production in severe 

 diabetes, has with the material at hand, not been supplied. 1 



Now as concerns the oxygen requirements, this in severe cases of diabetes 

 is undoubtedly increased. This may be seen in my tables. I find that the 

 oxygen requirements with otherwise similar heat production average in the 

 diabetics 4.59, in the normal individuals 4.24. 



i. This is also to be seen in the figures of Benedict and Joslin:^ That there 

 is an increased heat production, however, cannot be inferred from the in- 

 creased demand for oxygen. Already Leimdorfer mentioned that in the 

 severe diabetic through the loss of bodies very rich in oxygen, in the urine 



1 Remark on Correction. Also in a second publication that Benedict and Joslin made a short 

 time ago concerning this subject (A Study of Metabolism in Severe Diabetics, Carnegie Institu- 

 tion of Washington, Publication No. 476, 1912), this is shown in an indubitable manner. Here 

 are found statements only as to the carbonic acid production and the oxygen requirements; 

 in the severe diabetics there was a COz elimination : (P er kg. per min.) of 3.13 c.c. (according 

 to my calculation 3.25); in the normal individual of like weight this was 3.13. 



2 In the second publication, 4.54 O 2 per kilogram per minute in the severe diabetics as against 

 3.75 in normal individuals of the same weight. 



