Patients in my series of 100 cases summarized earlier in the article, seemed to do very well, presenting about 75 per cent of complete healing. Most of them were treated conservatively. It must be stressed that injections of pancreatic extract did not constitute the sole treatment in all the cases. The extract was administered in doses of from 1 to 3 c.c., either daily or on alternate days, depending on indications, in addition to an adequate diabetic regimen. Nor were other measures neglected, such as proper hygiene, asepsis, short wave diathermy, low fat diet, etc. Typical management of a case included: 1. 1. Papaverine hydrochloride gr. 1 4 Acetylsalicylic acid, gr. 5 Every three hours for pain. 2. 2. Keeping the extremity warm. Appropriate non-irritating dry dressings. 3. 3. Low cholesterol diet and indicated amounts of carbohydrates. Insulin when indicated. 4. 4. Spirit, frumenti 3 ss, b.i.d. The patients were encouraged to be up and about as soon as possible, in order to aid the utilization of carbohydrates and fats by increasing energy requirement. Since there is an optimal temperature which is most favorable for healing, we felt that the electric cradle might prove injurious in many cases and we therefore did not encourage its use. Similar objections based on the degree of stimulation may be raised against the various types of positive and negative pressure apparatus and for this reason these were not used in our cases. The usual diabetic management fails in many cases of gangrene, necessitating radical surgery. I attribute this to the lack in insulin of some substance present in the pancreatic extract (desympatone). In some cases insulin alone seems to disturb muscle physiology. This can be judged from the fact that many diabetics with angina pectoris have refused to take insulin or learned to be cautious about it, because anginal seizures were often precipitated following the administration of even small amounts. 34 34 Hyman and Parsonnet. Insulin angina. Ann. Int. Med., 4: 1247, 1931. On the other hand, when these patients are given insulin with pancreatic extract, their tolerance is restored. This may be due to the fact that in many diabetics there is a disturbance both in the lipoid and carbohydrate metabolism, and the effect of insulin, which is directed against the carbohydrate disorder alone, tends to produce a metabolic disequilibrium between the lipoid-carbohydrate relationship. Further studies along these lines are being conducted by my associate, Dr. Digilio, and other members of our group. The active substance present in the enzyme-free pancreatic extract, which is neither histamine nor choline, exerts a beneficial influence upon lipoid metabolism, as well as upon muscle metabolism in general. As a corollary to this, it may be that the combination of insulin, pancreatic extract and a diet low in fats, will prevent the early appearance of atherosclerosis in diabetes. In the event of the latter, it is possible to expect a decreased incidence of diabetic gangrene.