Thus the Nutrition Laboratory's introduction of the helmet with
its free, untrammelled breathing, full vision, and light closure
around the neck is a welcome replacement for the saliva-stimulating
mouthpiece or the tightly bandaged face mask. This apparatus I described
in one of my lectures. The helmet likewise does away with all work of
the lungs in opening and closing valves, but what is more important
from the standpoint of the operator, the latest modification of the
apparatus has become a direct-reading instrument. By introducing
a rotamesser in the oxygen supply line, one can read directly the
oxygen consumption for each minute. I found that this apparatus
attracted a good deal of attention but there was no great enthusiasm
over the idea of introducing it as routine hospital procedure. If
this is accomplished in ten years I shall feel satisfied. Personally
I feel it must ultimately prove its true value.
It is believed that another important procedure can be introduced,
in that the subject should not be lying. It is a psychological fact
that a patient sitting up will seemingly react far less to mental
disturbance than when lying completely flat. The metabolism of well-
trained subjects, it is true, is slightly higher when sitting up than
when lying down. On the other hand, if the subject is well supported
by pillows, such as for example in an English "club" chair or a well
arranged steamer chair or reclining chair, this difference is wholly
insignificant. Consequently it has been my tendency to recommend
that metabolism measurements in the clinic be made if possible when
sitting or in a semi-reclining position with the helmet and not with
the mouthpiece.
Above everything else it is imperative that each person
attempting to interpret basal metabolism measurements must from
previous experience, preferably on himself and a number of laboratory
(not hospital) normals, know what in the first place is normal and
secondly, what are the variations that can be expected with the normal
individual. If these two important points can be bettered, first,
better technique employed, i.e., the helmet and semi-reclining position,
and second, that the interpreter have personal experience on the
apparatus, it is fully believed that the basal metabolism will be one
of the most important adjuncts in the clinic. It is the only
measurement of the level of vital activity.
The metabolism of animals.
In the survey of metabolism studies in Europe I found various
laboratories with more or less activity with different groups of
animals, and it may be of interest to classify them in the following way.
Cold-blooded animals. Practically nothing is being done in the
gaseous metabolism of cold-blooded animals. One finds everywhere frogs,
but only in the laboratory of Terroine are metabolism studies active
and these in the line of nitrogen metabolism.