654 INSULIN IN HOSPITAL AND HOME
prolong the lives of many old and faithful patients rather than
to attempt to secure marvelous results with a few. Up to now
such improvement might have been at the sacrifice of the life of
another. The problem presented to us was to keep 60 cases, in
more or less desperate straits, alive. Marvelous results can be
foreseen from the moderate results in Table 1, and will in reality
be reported we hope from other clinics less pressed by accumu-
lated old patients.
There are four cases of the fifty-three treated who still are
taking less than 5 units a day. These patients have been much
helped by insulin. They have gained an average of 4 pounds in
a total of 53 days or one pound in 13 days. In contrast are 12
cases who are known now to be taking 20 units or more, and these
patients have gained an average total of 6 pounds in a total of 90
days. The largest number of units given a patient regularly is
60, and this patient, Case No. 2256, has gained but 5 pounds in
147 days. Her strength however has increased markedly, and
there is comparatively little doubt but that weight will come, too.
This patient developed diabetes in February, 1919, and when she
came for treatment in June, 1921, her weight had fallen to 72
pounds. Mental depression has been a factor of serious sig-
nificance in this case. This began originally in 1921. She recov-
ered from it when the urine became sugar-free, but in 1922, wvhen
improvement was slow with insulin, it returned. She has simply
existed since the summer of 1921 until insulin has begun to give
her a new lease of life. To some extent this patient's mental
condition can be attributed to false hopes aroused by newspapers
which are not published in this vicinity, for our friendly editors,
we are glad to say, have co-operated in refraining from the
temptation to get news at the expense of extravagant hopes
aroused in patients. She is now receiving 54 calories per kilo-
gram body weight. Her weight still remains 48 per cent. below
standard.
Summary of Protocols of Fifty-three Cases Treated with Insulin
The total number of cases treated with insulin since August 7,
1922, has been 83, and 53 of these are available for statistical pur-
poses. The remainder have either had insulin transitorily in
emergencies of some kind, later to be described, have been fol-
lowed too short a period to merit discussion (i. e., less than 15
days), or because of lack of insulin have been treated with