ELLIOTT P. JOSLIN, HORACE GRAY AND HOWARD F. ROOT 659
patients, and furthermore, were of a severer type, and that type
is usually not to be found in the obese.
Evidence of the severity of the disease and of the havoc which
it has wrought upon these patients is shown by the percentage
below standard weight at the beginning of treatment. In one
; instance this reached 50 per cent. and in 13 instances it was 30
per cent. or more.
During the first two weeks of treatment with insulin the weight
frequently decreased, and the average decrease for the 53 patients
amounted to 0.5 kilogram. The lowest weight during this period
was taken as the basal weight of the individual and the gain in
weight subsequently was computed therefrom. Loss of edema
and the low diet, prescribed in order to banish glycosuria, account
in large measure for this loss in weight in the first two weeks.
It is true that sometimes a gain in weight also results in the first
two weeks, because of the marked desiccation of patients at
entrance. In one instance this amounted to 9 pounds, but this
case does not appear in the table as he came for treatment within
the last 12 days.
The actual gain in weight for the different patients has varied
from 9.7 kilograms in Case No. 2802 to no gain in weight in Case
No. 2296 who has been but 15 days under observation. The
average gain in weight for all the patients has been 2.6 kilograms,
or 5.7 pounds per patient.
The percentage gain in body weight is a better guide to the
improvement in the patient following insulin than is the absolute
gain in weight. With some of the cases this has been consider-
able. It happens that the greatest actual gain in weight coincides
with the greatest percentage gain in weight; thus, Alice S., Case
No. 2802, has gained 25 per cent. and now weighs more than ever
before in her life. On the other hand, Case No. 2746, a little boy
of S years, has gained but 3.2 kilograms, but this amounts to an
increase of 20 per cent. for his tiny frame. The average percent-
age gain in weight for the 53 cases is 7.5 per cent.
The average calories per kilogram body weight taken by the
patients prior to the beginning of treatment was 26 calories, and
the average calories which the patients were taking according to
their latest reports was 38 calories. In one instance, possibly
two, the gain in weight has gone ahead so rapidly that the patient
now is actually receiving less calories per kilogram body weight
than at the beginning of treatment. These patients will serve