ELLIOTT P. JOSLIN, HORACE GRAY AND HOWARD F. ROOT 653
prefer very moderate doses. Overnutrition is harmful in health,
doubly harmful in diabetes, and we see no reason why insulin
should make it safe. We do not believe in diabetic patients
walking on insulin stilts any more than is necessary.
Insulin has revolutionized diabetic treatment in more ways
than one. First it can give more food, strength, and weight, but
secondly to do this it demands not only a knowledge and respect
for the diabetic diet on the part of the doctor and patient, but
adherence to the same, if the diabetic wishes to get his money's
worth for the insulin he injects.
For the wise, who may be rich or poor, young or old, and for
the innocent, who can be cared for, insulin is a benefit, but for
the ignorant, who likewise may be rich or poor and young or
old, it can be dangerous, and a gift of free insulin to such is like
casting away pearls.
Selection of Patients
Early in August a list of about 30 of the severest cases of
diabetes was made, chosen from those surviving diabetics treated
since 1898. To this number another group of about 30 severe
cases has been added from time to time, including several cases
representing surgical emergencies. Recently some twenty-five
other cases who were of distinctly less severe type, yet either
quite unable to maintain weight upon a diet which they would
tolerate or notable because of some peculiarity, have been
selected. To all of these patients insulin has been given. Of the
total number of 83 cases treated, seven are (to use Woodyatt's
term) "pedigreed" diabetics in that they have already found their
way into medical literature. These are Cases No. 632, 866, 1305,
1542, 1794, 2174, 2560. These pedigrees deserve a scientific dignity
far surpassing the current emphasis on the "family history,"
especially in view of the attention increasingly given nowadays
to "after-histories." Multitudes of case reports in the literature
are totally useless, for want of a follow-up.
Number of Units of Insulin Used
Most of the patients have begun with 1 unit of insulin one, two,
or three times daily, and this has been increased almost daily until
the requisite number of calories could be taken to allow a gain of
weight and of strength. It has been our policy to treat many
rather than few diabetics. We have felt it more humanitarian to