540 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



(sugar, ketone bodies), the relation between oxygen consumption and car- 

 bonic acid production is disarranged. Direct calorimetry actually shows in 

 the experiments made at the Boston Institute, that in diabetics with normal 

 heat production, the oxygen consumption is increased. 



2. In the experiments with the administration of meat the specific dynamic 

 energy of the protein and the time consumed in the decomposition of this 

 in severe diabetes was investigated. The question can, however, scarcely 

 be discussed, because the number of experiments is too small. 



3. The experiments with the administration of carbohydrates seem on 

 the contrary to be worthy of mention. In these investigations there was 

 sought to be determined whether in short periods (two hours) the respira- 

 tory quotient did not temporarily rise. The two experiments on this 

 subject agree very prettily. In normal individuals, on the administration 

 of just as much carbohydrates, we would expect an increase of the respira- 

 tory quotient to nearly i.o. In the two experiments on the diabetic the 

 respiratory quotient was hardly influenced, however. In the severe diabetic, 

 therefore, the administration of carbohydrates does not suffice to increase the 

 combustion of sugar. These experiments agree very prettily with the ex- 

 periment of Falta, Grote, and Staehelin on the dog without a pancreas. Also 

 here the respiratory quotient was not increased on the administration of 

 sugar. In both experiments on the diabetic the heat production rose some- 

 what in the first two-hour periods. This rise is perhaps to be referred to the 

 increased work of digestion. 



The manifestations on the part of the vegetative nervous system in 

 diabetics has only recently been made the subject of study. I have already 

 in the discussion of the experimental physiology mentioned Lowi's reaction. 

 Its absence shows an increased excitability of the dilator pupillae (innervated 

 by the sympathetic). We have tested this reaction in human diabetes on 

 a large amount of material and have found it positive in a number of cases. 

 We could not demonstrate that it is connected with the intensity of the 

 glycosuria or ketonuria. We sometimes found it positive in cases in an 

 aglycosuric condition, and in other severe cases; even in the presence of 

 coma, it was negative. The glycosuric action of adrenalin in diabetes has 

 been studied by Newburgh, Nobel, and myself. It was found that in cases in 

 the aglycosuric state, adrenalin in almost all cases leads to a distinct increase 

 in the elimination of sugar. On the contrary, in a certain number of these 

 aglycosuric cases, the action was negative. There were among these cases 

 that had to be regarded as severe, cases that only on the complete withdrawal 

 of the carbohydrate and strong limitation of the protein would be main- 

 tained sugar-free, and that on the administration of slight amounts of 

 carbohydrates responded with glycosuria. These investigations show the 

 independence of the nervous and alimentary factors at least in the aglycosuric 

 state. An especially intense action of the adrenalin on the heart and 



