VOLUiE 80 ENCEPHALITIS-RoSENOW 1583
NvoBER 22
the large general hospitals in Boston receiving such mouth to offset the insulin, and some of the most suc-
cmergency cases. With the expansion of the Deaconess cessfully treated patients have received a few grams,
Hospital to 180 beds, more of these patients may enter. from 15 to 30, of sodium bicarbonate. Promptness in
In coma, insulin, from published reports, is best given beginning treatment is everything.
in 10 unit doses every hour for about two to four doses, Insulin can be discontinued in a small fraction of
and then every other hour for four doses more, if nec- cases. Those patients may be able to omit it who
receive it temporarily because of an exacerbation caused
TABLE 2.-Foods Arranged Accordinig to Carbohydrate by complications, and some patients whose diabetes is
Content of recent onset, though perhaps the latter should receive
it intermittently as a prophylactic against increasing
-5% 15% 20, severity. Many such instances in children are under
1-34 % 8- 7 o%* ]5"7o 20%0
VEGETABLES (Fresh or Canned)
Lettuce Tomatoes String beans Green peas Potatoes oservaton.
Cucumbers Brussels Pumpkin Artichokes Shell beans To the Insulin Committee of Toronto, and through
Spinach sprouts Turnip Parsnip Baked beans
Asparagus Water cress Kohlrabi Canned lima Green corn itS recommendation to the Eli Llly Company as well,
B.hubarb Sakbale Squash beana rB o bae indete iic
Endivehubarb a kale Bqeash beans Boiled rce I have been indebted for the rare privilege of using
Enie Okra Beets Boiled
Marrow C ]ifliower Carrots macaroni insulin. For this I cannot be grateful enough. The
Sorrel Egg plant Onions
Sauerkraut Cabbage Green peas, contribution of Banting and Best to the treatment of
Beet greens Radishes canned
Dandelitgron Leeks cannd diabetes is greater than I ever expected to witness.'
greens String beans, 81 Bay Stae Rod.
Swiss chard canned 81 Bay State Road.
Celery Broccoli
Mushrooms Artichokes,
canned
FRUITS:
Ripe olive (20% fat) Watermelon Raspbies-os lums SPECIFIC SErRUM TREATMENT OF
Grapo fruit Strawberries Currants Bananas
Irmons Apricots F Prunes EPIDEMIC (LETHARGIC)
Cranberries Pears
Peaches Apples
Pineaches Apples ENCEPHALITIS
Hieppe )uckleberrlem
Blackberries Blueberries
Gooseberries Cherries FURTHER RESULTS
Oranges
EDWARD C. ROSENOW, M.D.
30 Gms., 1 Oz., Contain Approximately
r5~ ~ · ~~~~ROCHESTER, MINN.
Carbo-
hydrates, Protein, Fat, Calo-
Gm. Gm. Gm. ries By the use of special methods, a somewhat peculiar
Oatmeal, dry weight ................... 90 5 2 118
Shrteaddod wheat.23 .........H. - 2 3 3 10 4 streptococcus has been isolated from infected tonsils,
Shredded wheat .. ................... ... 23 3 0 104
Uneeda bisacuits, two................... 10 1 1 53 teeth and nasopharynx of patients suffering from vari-
Cream, 40% ...................1........ 1 1 2 11e
Cream, 20fo........ ................. 1 1 6 62 forms of encephalitis. With this streptococcus,
Brazi l nuts............................. 2 19
Brazilnuts 2- 5 20 208 ~~~typical symptoms and lesions of encephalitis have been
Oys ters, si ........................... 6 1 49 reproduced in animals. The type of the disease induced
Meat (cooked, lean) ................... 0 8 5 77
Chicken (cooked, lean) ............... O 8 3 59 experimentally often resembles that existing in the
Baeons'. ' ' s-............ 0 8 15 1315 patient from whom the strain was isolated.l In the casc
e e se............................... 3
Egg, one .............................. 8 6 of the strains from epidemic hiccup, a form of myo-
Vegetables, 50% group ..... 1 0.5 O 6
Vegetables, 10% group .2 0.5 0 s0 clonic encephalitis, it is possible to reproduce spasms
Potato .................. 1 O 28o
BPo taato.18........... 6 1 0 28 of the diaphragm and other muscles not only with
Bread .. ................................ 18 3 84
Bu tter . .. 25 225 living cultures, but also with the filtrates of cultures
O i l 0~~~~ 0 10 2,
FishnO .....: cod, haddockrh(co< . o ( c0 24d ' and the dead bacteria.2 The organism varies greatly in
Fish cod hadock cookd)........ 800 24
Broth................................. 0.7 0 3 size and shape, depending on the method of cultivation.
It has been cultivated from filtrates of nasopharyngeal
* Reckon average carbohydrate in 5 per cent. vegetables as 3 per
cent.; of 10 per cent. vegetables as 6 per cent. washings, and from emulsions and filtrates of brain and
medulla in fatal cases.3 Large and small forms of
the organism, sometimes in the same chain, have been
TABLE 3.-Results of Treatmfent
TABLE 3.-Resuts of Trezet demonstrated in the lesions in undoubted cases of
SUMsMARY OF 127 PATIENTS WITH DIABETES TREATED WITH INSULIN
AnD DISCHA RGED o TO TsEI HOME PHYSICIsNS encephalitis, and proved absent in adjacent normal
tissues, and in the brains of persons who have diedl
Durslmn o rrroatmonî from other causes.0
Duiration of with Insulin
Age at Onset, Dlsease, , ..-_ . Gain In view of these and other facts, may it not be pos-
Yracs Yeacs Dura- bi/lts Weiglht
YNo.of rtiona, Y eair,~_._.. sa ble that the organism with which I am working is
No.of ~---h~c ~ ·-~ tion,Dalr---
Cases Aver. Range Aver. Range Days Aver. Lbs. % the larger aerobic antigenic form of the smaller anaero-
127 29 1-65 4 0.3-20 107 il 4 5
ssnsaoTnaun or Dr sn su n 1 5oas bic, relatively nonantigenic form isolated by Loewe and
INSULIN IN THE TREATMENT OF DIABETES IN CHILDREN 15 YEARS
OF AGE OR UNDER
31 7 1-15 2 0.3- 8 122 10 11 1. A summary of the work of the Toronto group on insulin appeared
1 810 11 in the Journal of Metabolic Research 2:125 (Aug.) 1922. An early
PATIENTS TAKING 6 OR LESS UNITS DAILY article by Banting and Best appeared in the Journal of Laboratory and
(CHILDREN UNDER 15) Clinical Medicine 7: 251, 1922. A more recert clinical article by
13 ( 1-13 2 0.3- 4 89 4 3 Banting, Campbell and Fletcher appeared in the British Medical Journal
1:8 (Jan. 6) 1923.
1. Rosenow, E. C.: The Production of Spasms of the Diaphragm in
Animals with a Streptococcus from Epidemic Hiccup, J. Infect. Dis.
esça~~ry. Oe soul bever catioç bf322 :41-71 (Jan.) 1923; Experimental Studirs on the Etiology of Enceph-
essary. Que sbou-îld be very cautious before giving more alitis: Report of Findings in One Case, J. A. M. A. 9: 443-448 (Aug.
than 60 units in twelve hours. Few cases have required 5) 1922.
2. Rosenow, E. C.: Production of Spasms of the Diaphragm in
more than 100 units. The blood sugar percentage and Animals by Living Cultures, Filtrates, and the Dead Streptococcus from
the urine sugar, in addition to the clinical state of the Epidm Hiuup, J. afnut. Dis. 22: 72-54 (Jan.) 1923.
3. Rosenow, E. C. (Footnote 1, second reference).
patient, are the best guides in treatment. .In some cases 4. Rosenow, E. C., and Jackson, G. H., Jr.: Microscopic Demonstra-
~~it may be safer togive 5 or 10tio o crinf Bacteria in the Lesions of Epidemic (Lethargic) Encephalitis,
it may be safer to give 5 or 10 gm. of carbohAyurate by j. Infect. Dis. 32:144-152 (Feb.) 1923.