558 INSULIN IN THE TREATMEN 0F DIABETES MELLITUS
to 60 units. The injectionsre then discontinued until November 2,
when 90 units were given ly for four days and 60 units daily for three
days. On October 26 e diet was increased to protein 50 gm., fat 207
gm., carbohydrate 261 gmin. He was absent from hospital from November
8 to November 29. During this time his diet was approximately protein
48 gm., fat 138 gm., carbohydrate 48 gm., and he received 40 units of
insulin a day. Daily examinations of the urine and occasional fasting
blood sugar estimations were made by Dr. Joseph H. Barach of Pittsburg.
Dr. Barach was kind enough to send us his results. He returned to hos-
pital on the 29th of November for three days, and again for a third period
from December 8 to January 8, 1923. He continued his diet of protein,
48 gmn., fat, 138 gm., carbohydrate, 48 gm. until December 23, and from
then on 56 gm. of protein, 180 of fat, and 60 of carbohydrate. From
November 29 to January 8 insulin was given in amounts varying from
20 to 60 units a day.
General progress: When admitted he was so easily fatigued that prac-
tically no physical exercise was attempted. Regular insulin treatment
was begun September 20. On the second or third day he referred to a
feeling of increased well-being. This might be the result of the clearing
up of the ketosis. From the 6th to 12th day the insulin given was low
in potency and further progress was not much in evidence. During the
second two weeks of insulin treatment much more rapid improvement
took place. Especially evident was the increased physical vigor. Even
on this diet of 1490 calories he could take walks of four miles in an
afternoon without difficulty. He lost his flabby appearance and his general
bearing became one of increased vigor. From October 18 to November
2, the period when insulin was stopped, he retained his feeling of in-
creased strength to a considerable degree, although when the diet was
increased on October 26 severe ketosis developed. Insulin administration
was resumed on November 2. With this treatment, along with this in-
creased diet, he said he felt in the best of health. He was in very good
spirits and so enthusiastic that his actual state of physical fitness could
scarcely be gauged. He was not encouraged to take much exercise but
he enjoyed what he took. He ate his meals with relish but did not have
the insatiable hunger of the diabetic. On November 8 he returnedc to
his home, and for most of the next three weeks he carried on his practice,
seeing clients, going into court, and completing some of the work which
was in arrears. He stated that his power of application for work of this
sort was as good as before the onset of the disease. During the second
and third periods in hospital it became evident that his improvement
was well established. He spent, as a rule, the morning in hospital but was
out of hospital for as much of the day as we would allow. He went for
walks, sometimes in the snow, without fatigue. At end of November he
contracted an upper respiratory infection with a rise in temperature of
a degree or two, Fahrenheit. This infection subsided quite rapidly and
required no treatment other than remaining indoors for two days. During
the period of convalescence the anemia was in a large measure relieved.
At time of adminission the blood hemoglobin was 30 per cent.; on September
29, 30 per cent,; on October 27, 65 per cent.; on November 6, 80 per cent.