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So although metrazol is widely used, a large number of psychiatrists condemn it as a "very dangerous drug." Some use it only in alternation with insulin. Dr. John Robert Ross and Statistician Benjamin Malzberg of the New York State Department of Mental Hygiene, reviewing 1,140 metrazol cases last week, said that only 1.6% of the patients recovered, only 9.9% were "much improved," 24.5% were "improved." In a group which had no treatment at all, said the doctors, 3.5% recovered, 11.2% were much improved, 7.4% were improved. Most experts now agree that, despite a few spectacular cures, metrazol is far less effective than insulin. A few laboratory workers are experimenting with kindred drugs, trying to concoct a less dangerous substitute.
Insulin. Insulin, by reducing the amount of sugar in the blood, deprives the brain of its chief nourishment, somehow producing a coma—well-known to all diabetes sufferers who have ever given themselves an overdose of the drug. Usually about 20 units of insulin are injected into the veins of a fasting patient early in the morning. Next day the dose is slightly increased. For the first few days he sweats, blinks, complains of drowsiness. Finally, on a day when he receives about 70 to 100 units, he sinks into a coma. His skin may turn paper-white or cherry-red, and, snoring like a horse, he puddles his bed with perspiration. After three-quarters of an hour or an hour, he is given sweet foods or glucose injections to revive him. As he gradually awakens and crosses the border of consciousness, he shouts and bellows, gives vent to his hidden fears and obsessions, opens his mind wide to listening psychiatrists.
Great danger of insulin injections is "irreversible shock," caused by too little sugar in the blood. This shock may occur when a patient is allowed to remain in coma over an hour. Even glucose will not revive a deep shock victim, and he may remain in a coma for hours, days, even weeks. Finally he may die from respiratory failure. Standard treatment for irreversible shock is blood transfusion plus glucose injections. "The dramatic psychiatric improvement following prolonged coma," wrote Drs. Joseph Wortis and Richard Hooker Lambert of Johns Hopkins Hospital last week, "suggests that if a safe method for prolongation of coma could be devised, it would further extend the value of shock treatment."
Figures vary on the beneficial results of insulin treatment. Famed Psychiatrist Edward Adam Strecker of the University of Pennsylvania, who works at the best-equipped shock clinic in the U. S., claims that 30% and even 40% of insulin-treated patients return to normal living. "Insulin therapy," he believes, "offers more hope in the treatment of dementia praecox than was ever offered before by any other treatment." But Psychiatrist Stanley Cobb of Harvard, who has never personally administered shock treatment, holds that the risks far outweigh the advantages.