9;8 ' Nov. îz zqs2J -_CORBEPNDINECB. _.u- -
dispense with the services of the two visiting purgeons the ment were sound, and I fe1t I had discounted my own malais
following resolution was passed: .ud mr patisi' evident is after tse injetbns a-il
'Ws, the medical practitioners of Limerick, have learned with too ligitly.
surprise ihat i6 is proposed to disperses wtth tfie uer4icéu 9f Dr. Hillier, atth e(thGnerai Hospital, at this stsgeverykiudy
the two visiting surgeons to the Limerlclk Clty tlo 'sa nda undertook to examine thoe pancreas of different animais in;
Htospital, snd to replace them by a jmior residn$ doator. order to discover the distribution çf the islets of Langerhans '
We protest very earnestly egainst this changeinvolvin g a withaviewto obtainisg a fors polentextravtof 1he is1ts-
great injustice to two gentlemen who have for more t tan
twenty years efficientlyand fathfully discharged their duties by using only those portions of the pancreas in which they:
W this lst!tutien aud aso s kreat Injustice te tise poer, appesred more numerous. It ij worth while recording that -
who wll be thus. prived oe tie-services oe these very experi- Dr. Hillier and I fouhd that our crude extract, wbicih prodated c
e,nced practitioisers; whlle te ortelbavers any aviug effeted such remarkable effecta on intravenous injection, wse quite
will be se trifling as to bh abiolut.ly negiigbla. We would * a
point out that it is quite illegal for sny medical man who is nert tn vtre.
not su apothecary te compeuud tise prescription otanoîher." About this time I had the opportunity to investigate tis:
....._____________________________ effect of iniravenous injections ot oher substances thisa tise
crude pancresat extract I hadd heen using. In a patienl'
*u&deegoing treatmet for astima I found a lowering f 'tie
curve after as intravenos injection of peptone. I have sinoe:
- _: found that salvarsa intraveniosly and even T.A.B. vaecine
TUE DOS:I 0 THYROID. limite the normal alimentsaryhyperglycsemia after 100 grams
THEDSEO T'ROXD. of ginecsc in some patmentu i
Sssî,-My attention has been Qifr by my pharmaceutical e cse lo patients.
y my ~~~ I came te thse conclusion tisat tise results tisat I isad'
colleagues to the dose of dry tiyroid gland which is given in oiserved after tie injections of psncreatic extract wnre nuÉ-'
the Brutesh Phare as 1/2 toe 4 grains Physicians specific. For tihis resson, until I have had an oppoethtU :
uuing tise glsnd in lscspital peactirie genewly phoribe it n of examining the controls practised by the Toronto Sohôol;
this form, whioh i. di.psused u tis.hbehspital; sud it l. lu 14555 -I shal reserve my judgement of the ultimate value of insni '
way tliat tudeata obtain tisr knewlge of the dose and uses Tie crucial test wil b. that of clinical experience.
cf thyroid. - - : - It would take too long adequaiely to discus ti signifi.
* In private practice the gland is given almost alway s cf the curions tact tbat injections wiich fatten tie
tablet form, sud thse doe is weighsed as fresh gland, whisc alimentary curve in a norl prson only very -ligihtly
representa only about ouso5fiL ot- th sdry gland. That le, if reduce it in the case of a diabetiq. I have had no experience
tise physician ordere 1 grain cf tsyeoid -gland tise patient of work with animals after pancreatect0my, but I still remain
receives 1/5 geais df tise Britiuhs Phers*roeeysoeia tisyroideum a little sceptical after fairly extensive reading of the tito.,e-
5100'm. : . : . -... ture whether the condition of animals after that operation ia
I have reason 'te know tisat mieunderstanding o hs a~
Ias oaveured.-I ao kn,s etc., m'linderta g of tisese tacts exactly equivalent to the extraordinary variety of conditions
in man which are coUecled under tha name "diabetea."-
Cambridge, Noe.'lh. ' W. E. DIXoON. I am, etc.,
Birm.ngo,an. Ber . A. P. TaoesOu~
INSULIN AND DIABETES.
SIB,-TThe General Statemest* o" theia Physiologieul and T T 0 E
Therapeutic Effects of Insulin, publiahed by Professor Macled THE OBJdCT OF INVESTIGATI~0N 4 T '*
in the Jouasm of November 4th, leads me to place on record ST. ANDREWS CLINICAL IlSTITUTi.'
certain results of work with wishs I have been engaged for Sr,-Frem tie notices that appear lu lis medic su
the past thzse yeara. The full particulars of this work I hope press tier. i8 some danger that our modeet enterp l
to publish shortly. Some of tise prov .o' conoclusions that may become fasiiorable before it la undaratoo. Sema
I had resuhed were set forth ia sleture wsich I deivered teachere tell ce that hhey have beau doiug for aong time
'before tise.. - irminghsm usch of the 'Brit'ish Medical what we are attemptiug, in that they have kept in touch with
Assoclation s jear a«o -,.the out-patient department and taught students the early
:It ij nowv establubod tiat,in normal animas sud man, after srmptems of disese. I have beau engaged te tie study et
the lngestioh of glucose by tis mouti te o..rs a deflnite t ese early symptoms for ovar ihirty years, and if I were
truanitory morasse in tise sugar of gss bloocd, tise xtant of asked to teoch studeuts this subject I would decline, for the
which may be fairly sarstsly. de toragmel bhy repate esti- simple reason that*my kuowledge is tee scant.
mations o f tise blood ah- short intorvala Isoler. sud atter tise 31dMdicine is toe-day so befogged that it cannot aee tie palh
administration of tbs glucose. of progrus. nor'uuderstantd it own limitations. A conuldera-
It occurred to me tsat it wonld be intarestiDng to ascertain tion cf the state of knowledge on sone subjects and a glance
whether the extant ad duratism of the normal alimentary back over the course whics medicine has pursued may reveal
hyperglycaemia could be modi'Id by intravenon injections where it has gone astray. In the middle of last century the
eta bol[ed asd ltaed wetry e$xtrot of the pancreas wvich study of d' orgsn, as revealed on tise poat-mortes
conceivably would contain oahmim' sb e. table, attained such im portace thathsology was assumed
, to be the foundation of medicinle It. wsa imagined thlat th
l?or the purpose cf earlet 1tousa rabbis.. Tise blood sgv usnature ot ill health aDd the caue_ of death could be fornd
curve was detemnled sitr 10 pmss o cf ghtes ihad hee thera. In conset1 _u_e' of tis ph]ysciaus began to search
introduced into tise stomachs by a tuba. Â week laier wîisthe thertieags!
same animals I determined the curvta l exactly aimilar condition for the signs omagd organ duriag life, and ,8 laid
except for the iutravenous injection ot a small quantity oi the tise basisa of that diagnosis by physical signa whicb has
extraet. The result wase very strilkng, for the alimentary typer- aver aine dominatsd cîlnical medîcine, sud thus diverted
enrlyoaemla 'istenin was very dafinîta latise lIaI experîmeut 'vas attention from tise real cause of ill health.
entirely absent lu the seconed. I confirmead tise recuit wvith otiser N oitptslg ee ra au,Iu iemaaely
rabbits, and none of tiss animals anfferd any apparent ill No dobt pathology i s of 1reat value, t the miutako1ty,
effects. as happens so often in medmione, in expecting a subject to
The next step use to conduct a similar experiment on a normal yield a kind of information whiich it is not capable of doing.
man, asd inasmuch se my oolleagues at the General Hospital tFe examinatien cf a dad body may reveal s damaged
wvers doubtful if suchs an experimant 'vas Justifiable I injealr iactriovleo ulfaed thuu,btteeaentts
werdoutthit8â6bveintp;lob^n« ">u8er leilaten gcardiac valve or an infaed lung, but these are not the
extract iute my ownu vain. and obtained a c.sssiderable flattenlu sue tdais,urd e contgo iesypeee
of my normal blood sugar rum atter a dose of 50 grams of cause8 of de ath, nor do they account for the symptoms of
glucose by the mouth. Subsequently I had a headache nd fIelt ill the antecedent ill health.
for a few hours, but se far as Iknow the injection had no ill effect. The body i8 maintained in health by the harmonious work-
I next iujeced tise extrat insraveneusly lu s diabetie tter a ing of all the organa. Each organ possesses a mechanism
standard test-usai, haviug prevonsiy detenmiued tise raspensa et wihich regulates its function, so that the organ i able to meet
tabicotmea tbiscae Iobied 4 s nt he ever.varying demands made upon it by the conditions
hypergiyoaemîa, but the affect 'vas lu ne way comparable lu -j- disfrsue.e ii eiaim'iii
degree with the fall obtaloed in my owvn case. In this patient life. It is the disturbance of t his mechanism weich
I sater injected the extract severil times in one day, but only provokes the condition of ill health and leads to death.
sueoesded lu reduoirsg tisehyperglyeaeesta shighy. Bse rom- Tis damaged organ, and particularly ti he impaired tuncticn
usuainc pavlera! eadach sud ea few shou I uteovrdis.r cf tise organ, msy occasion tisis disturbsanoseto tise reguhahing
mehanism, thus producing the symptoms of ill sealth or
Aisout ins ttsaaa er trtling fatNality ocourred in one causing death. The ohsange in the organ itselt ie only an agent
is h uds I W5S lad to 5 'sd that tie 'iich may ori$inate the- disturbance. In- the same way ill
m'_/_4_l*t~ ~ tmmam~ * heal th due to mîcrebio invasion is not due to the microbe, but