652 INSULIN IN HOSPITAL AND HOME
hydrate 76 gramns, protein 37 grams, fat 46 grams, calories 59 per
kilogram body weight. Aune remained sugar-free eventually
with 3 units of insulin in the morning and the same dose or at
times none at night.
Insulin is a remedy which is primarily for the wise and not for
the foolish, be they patients or doctors. Everyone knows it
requires brains to live long with diabetes, but to use insulin suc-
cessfully requires more brains. Two ignorant patients, who were
helped by insulin and needed it, went homne without wishing to
take it, and their physicians, though living nearby, did not take
the trouble to come to the hospital either to see the patients or
learn about insulin. An alert little girl of 15 after six weeks of
dietetic treatment and a little insulin was not sugar-free on 36
calories per kilogram, yet she was wise and with insulin has
gained 21 pounds, 25 per cent. of her body weight. Her elderly,
over-worked country doctor traveled 150 miles to see for himself
this new form of treatment and continued it at home!
For two years Mary G., nine years of age, has adhered to her
rigid regime, fasting one day weekly and never eating over 732
calories in 24 hours. She remains a shadow, but like Pershing
before Lafayette's tomb, she is "here," and now her mother has
the satisfaction of watching her eat a saucer of oatmeal at break-
fast. She knows how to take her own insulin. Mrs. B. has
learned, through love and innumerable Benedict tests, that
Billy B. needs but one injection of insulin every third after-
noon, provided he has one injection each morning. Thus with
4 units every third day and 2 units the others his calories have
been increased 34 per cent. and his weight 3 pounds from the
lowest level.
The number of diabetics who have been admitted to institutions
under our care since insulin was received August 7, 1922, is 204,
of whom 83, or 40 per cent., have been treated with insulin. Save
for the boy who died 7¼ hours after he entered there has been
no death from coma in the hospital during this period. Further-
more, there has been no other death from coma among the cases
treated with insulin after they have been discharged to their
homes. The statistics upon which this paper is based end Janu-
ary 25, 1923.
Small doses, usually under 30 units a day, have appealed to us,
feeling better satisfied to see many patients gain a little than a
few patients much. Even now with insulin more plentiful we