INSULIN IN HOSPITAL AND HOME.
ELLIOTT P. JOSLIN,
HORACE GRAY AND HOWARD F. ROOT
From The New England Deaconess Hospital, Tke Corey Hill Hospital,
and The Leatherbee Diabetic Boarding House, Boston
Introduction: During each successive month since August 7,
1922, vwhen the insulin treatment of diabetic patients was begun
in this clinic in Boston, confidence in it has increased and our
original expectations have been more than fulfilled. The clinical
benefits reported in the publications from Toronto1 2 have been
fully confirmed. To our severest cases, selected with deliberation
from those treated during the last 24 years, it has given additional
food, weight, and strength of body and mind.
Insulin* is not a cure for diabetes, but it is a potent preparation,
alike for evil and for good. Thomas D. omitted insulin for 5
days, continued his diet, developed a mild infection, and entered
the hospital to die seven and one-half hours later of coma. A
patient with a tolerance for 114 grams carbohydrate took one unit
and the blood sugar fell to 0.03 per cent. Conversely Miss M.,
our first case and the severest diabetic on our list, who had gone
down to the street from her apartment but once in 9 months,
felt able after 6 weeks of trPatment to walk with ease 4 miles
daily, has gaitled 10.5 pounds, and now cares for her invalid
mother. Mrs. M1. nith rapidly ascending gangrene, fever, 5 per
cent. sugar, and marked acidosis, was first seen Sunday evening,
brought to the hospital, given insulin, and the thigh amputated
at 10 the next morning by R. C. Cochrane. After 8 days the 30
unit daily dose of insulin was omitted; 10 days later she became
sugar-free and remains so today while upon an adequate diet.
With similar temporary help of insulin, Mrs. D. successfully
withstood two carbuncles, the second requiring an incision 10
inches long. Aune N., three years of age, was on the verge of
coma, came out with insulin, and was discharged taking carbo-
*All the insulin (iletin, Lilly) used in the treatment of the patients and in thc
investigations here recorded was furnished through the courtesy of the Eli Lilly Co. upon
the recommendation of the University of Toronto. To their manifold and unvarying
helpfulness and k:tln ~s durino all these months, expressed through Dr. G. -I. A. C!owes,
Dr. A. L. Waiters, a:d Mr. Irvin Paige, we extend our cordial thanks.