One by one the bulwarks of the doctrine of the conversion of fat into glucose have been shattered, and it may now be relegated to the realm of scientific superstition.

Among the earliest investigations of Pettenkofer and Voit2 was a respiration experiment on a diabetic individual. The authors compared the metabolism of a diabetic with that of a normal man, as indicated in the following table:

Comparison Of A Normal And A Diabetic Man

It is seen here that the fat and protein metabolism are increased in order to compensate for the non-combustion of the sugar. Several years later, on the basis of these experiments, E. Voit calculated that a diabetic on a moderate mixed diet yielded 1015 calories per square meter of surface, while the normal individual of similar build produced 1020 calories.

The diabetic condition, therefore, does not involve a decrease in the quantity of energy produced, but only an alteration in the source of the energy.

In 1910 DuBois and Veeder3 published experiments accomplished with Pettenkofer-Voit respiration apparatus in Kraus's clinic at Berlin, which showed that a diabetic patient produced 5 per cent, more heat than a normal man of the same size, the food intake and the amount of muscular activity being the same in both.

1 Murlin, Edelmann, and Kramer: "Journal of Biological Chemistry," 1913-14, xvi, 79.

2 Pettenkofer and Voit: "Zeitschrift fur Biologie," 1867, iii, 380.

3 DuBois and Veeder: "Archives of Internal Medicine," 1910, v, 37.

Rubner1 found the metabolism of a fasting dog was the equivalent of 477.8 calories per day, which rose to 510.4 calories after the administration of phlorhizin, an increase of 7 per cent. This increase Rubner rightly attributed to the specific dynamic action of the increased protein metabolism. Lusk2 has reported an increase in the heat production of 70 per cent, after administering phlorhizin to a dog.

The same influences are active in the depancreatized dog, the heat production being increased 42 percent., according to Falta, Grote and Staehelin, and Murlin and Kramer.3

In the phlorhizinized man of Stanley Benedict (see p. 455) the protein metabolism did not increase as happens in other species, and it is therefore open to question whether there was any increase in his total energy production.

The question of the total energy production in the human diabetic has been extensively studied by Benedict and Joslin4 and by Allen and DuBois.5 Whatever of criticism may be found in the following lines, it is to be borne in mind that there is no question of the absolute accuracy of all of this work; the criticism only regards the interpretation. Pfluger has truly stated that criticism is the mainspring of every advance and the Altmeister added, "deshalb ube ich es".

Lusk6 criticized the first publication of Benedict and Joslin and computed that the average increase in metabolism was not 15 per cent, above the normal, as was stated, but did not exceed 5 per cent. The second publication of Benedict and Joslin maintained that there was an increase of between 15 and 20 per cent, in patients suffering from diabetes, and attributed the increase to acidosis.

1 Rubner: "Gesetze des Energieverbrauchs," 1902, p. 370.

2 Lusk: "Journal of Biological Chemistry," 1915, xx, 598.

3 Falta, Grote, and Staehelin: "Hofmeister's Beitrage," 1907, x, 199. Murlin and Kramer: "Journal of Biological Chemistry," 1913, xv, 380.

4Benedict, F. G., and Joslin: "Metabolism in Diabetes Mellitus," 1910; "Metabolism in Severe Diabetes," 1912.

5 Allen and DuBois: "Archives of Internal Medicine," 1916, xvii, 1010. 6Lusk: "Science," 1911, xxxiii, 434.

The establishment of an accurate method of determining the basal metabolism of normal men through the labors of DuBois has given a method of interpretation of metabolism results which has not heretofore been available. If the height-weight chart of DuBois be used to obtain the surface area and be applied to the diabetic cases and normal controls of Benedict and Joslin ("Severe Diabetes," Table 132), the following calculations may be made:1