102 AMERICAN DIABETES ASSOCIATION
Less than a year after the initial decision to investigate
the clinical merits of Banting's pancreatic extract we had
fifty cases under observation, some of them for many
months-a reasonable guarantee that no late effects would
vitiate the earlier results. We decided to offer a paper to
the British Medical Journal and it was accepted3. Prob-
ably few of you have read it, but I am still proud to have
my name on it. For clear, careful and complete presenta-
tion and felicitous phrasing, necessarily condensed into a
few pages, it is at least the equal of anything written on
the subject subsequently. The hand that held the pen is
unmistakably Fletcher's. Litera scripta manet, his father,
the late Professor of Latin, might have said. Essentially
the paper confirmed our preliminary observations and ex-
tended our clinical knowledge of the phenomena of dia-
betes under insulin. Coma was treated with success; the
state of insulin-hypoglycaemia in man was described and
treated and plans of diabetic treatment with insulin were
discussed. Further estimations of the respiratory quotient
before and after the administration of insulin confirmed
our earlier conclusion that carbyhydrate was utilized by
severe diabetics under the influence of insulin.
Through the kindness of the editor, Dr. F. M. Allen,
a whole number of the Journal of Metabolic Research4
was devoted to the investigations on insulin carried out in
Toronto and in our associated clinics in the United States.
In these papers a very considerable part, indeed the most,
of our present clinical knowledge of insulin is presented
by one group or another and, in general, confirmed by the
others. In them the physiological aspects of the problem
as it appears in man and the clinical aspects of the thera-
peutic application of insulin in the treatment of diabetes
and its complications have been discussed in detail and
illustrated by example. By this cooperative effort, there
can be no doubt that the proper use of insulin in the treat-
ment of diabetes was accelerated by years to the great and
lasting benefit of many, many patients.
Since such diabetics no longer exist, you younger men
must see the pictures of Buchenwald to gain an idea of
the state of human misery attained by severe diabetics in
pre-insulin days. All grades of severity existed then, of
course, but the state of denutrition, depression and black