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GLYCOSURIA COMPLICATED BY GALL-STONES
846 " THE LONDON
CLINIC."
of THE LAXCET. SIR,-In view uf certain publicity which has recently been given to the London Clinic (founded and maintained by the British Humane Association), we, the undersigned, wish it to be known that we have severed our connexion with that body. To the Editor
We are. Sir. vours faithfullv. DAWSON OF PENN THOMAS HORDERAdvisory Committee. REGINALD C. JEWESBURY, L. D. BAILEY, J. F. CARTER BRAINE, G. MURRAY LEVICK (Hon. Medical Director), E. P. CUMBERBATCH, STANLEY MELVILLE, C. A. ROBINSON. S. L. HIGGS, D. V. HUBBLE (R.M.O.), April 8th, 1927.
chronic pancreatitis. The latter may be the explattation of the low threshold in Dr. Shapland’s case. It has long been recognised that glycosuria is a relatively uncommon result of the chronic interstitial pancreatitis associated with gall-stones and that when it occurs it is of a mild type. But the disease is usually progressive and, although operative interference may bring about an improvement ill the patient’s carbohydrate tolerance, it is often unly temporary and frank diabetes ultimately develupa. I have several patients in whom this series of events, spread over as long as ten years in one instance, has taken place and they are now being kept alive only by the use of considerable doses of insulin. While, therefore, I agree with Dr. Shapland that removal of the diseased gall-bladder in his case was probably the deciding factor in the alleviation of the diabetic condition, I should be doubtful whether the recovery will be permanent. I am, Sir, yours faithfully,
P. J. CAMMIDGE. Nottingham-place, W., April 9th, 1927.
INFLUENZA: A PERSONAL STORY. To the Editor
of
THE LANCET.
recent attack of pure influenza SIR,—During I reflected upon the field of action of the germs, or of their conflict with phagecytes. The influenza was pure" inasmuch as none of the germs which are usually loafing about the throat took part in the frolic. After breakfast I had done my chores in the garden (my gardener is free on Sunday), and returned to the house without an inkling of impending trouble. There was absolutely no symptoms ; yet unwonted disinclination to starting for church aroused suspicion. Temperature 100.6° F. Later in the day the raised temperature caused the epithelium of the throat the secrete clean white mucus, which provoked a cough. For three days I put nothing into my stomach but water and carbonate of soda, this in my personal experience being the only means of avoiding the misery of flatulent distension which results from taking food when the digestive secretions are in abeyance, and a high temperature favours It was clear that the skin, muscles, fermentation. and interstitial lymphatic tissue were not affected. During this period and the succeeding two days the clear urine was the colour of dark brown sherry. The Destruction of blood pigment was going on. liver was certainly within the field of operations. No food and a motion every day had emptied the lower bowel before, on the fifth morning, I passed a very large quantity of black inspissated bile, which had collected in the sacculi of the colon. The hæmolytic capacity of the germ may possibly afford a clue to its identity. Until I discovered that I was feverish I but was head to head with members of my family ; they escaped. This seems to show that in the earliest stage of influenza germs do not escape into the breath. I am. Sir, vours faithfullv. ALEX HILL. 1927. April 7th, a
GLYCOSURIA COMPLICATED GALL-STONES To the Editor
of
BY
THE LANCET.
SIR,—In connexion with the case described by Dr. Shapland in your last issue, may I point out that, in my experience, an abnormally low threshold for glucose is not uncommon in diabetes. The systematic chemical analysis of the whole blood made in all my cases has shown that, as a rule, this lowering of the threshold is associated with a subnormal percentage of calcium upon which it appears to depend, for the threshold rises if the percentage of calcium increases. Partial exhaustion of the parathyroids as a result of chronic toxaemia appears to be the most common cause, but, since disturbances of calcium metabolism occur in connexion with inflammatory affections of the pancreas, as I believe I was the first to point out in 1904, it may also arise as a consequence of
THE GLUT IN WOMEN DOCTORS. To the Editor
SIR,—The glut in
of
THE LANCET.
women
doctors still continues.
single advertisement inserted in a London weekly medical journal produced 48 applicants for twu posts-viz., those of senior and junior resident medical officers to a children’s hospital in the Xurth of England, the salaries being £120 and £1 00. Recently a like advertisement brought forth only 12 male A
candidates for the
post
of house
physician
at
our
general hospital. None of the former applicants gave her age as 29. Thirty-eight of the candidates had held previous hospital appointments lasting from 2 tu 50 months. Many had gone from post to post. All the applicants were University graduates except one, who held the diploma of the London Conjoint College and she is a R.M.O., in a homoeopathic hospital. Twenty-three had English qualifications. 21 Scottish, and 4 Irish (one from north Ireland and 3 from the Free State). The 23 English women had degress from Oxford 1, Durham 4, London 10 over
(University 9, Conjoint Colleges 1), Birmingham I, Liverpool 3, and Manchester 4. The 21 Scottish graduates were 3 from St. Andrews, 6 from Edinburgh, 8 from Glasgow, and 4 from Aberdeen. The Irish graduates were 1 from Belfast and 3 from Dublin. The large number of Scottish applicants were out of proportion to the numbers qualifying across the border. Of over 2000 new names added to the Medical Register last year from Great Britain, twothirds were from England and one-third from Scotland, although Scotland has only one-seventh the population of England. The Oxford graduate was appointed senior and a Durham graduate, who had local influence, junior medical officer. With regard to the excessive number of graduates (men and women) entering the profession in the face of a fallen and still falling sickness rate-the Medical Register already contains over 53,000 namesit is said that out of every three qualifying in Ireland two must emigrate, and the proportion must be higher from Scotland. The celebrated Abernethy at the first meeting of his annual class of medical students used to exclaim, " Good God. gentlemen, what will become of you all ? So we may say to-day. Some of the best American Universities (Pennsylvania, Baltimore, &c.). restrict their medical students to a fixed number, which can be adequately taught the practical side of their work, some of them admitting less than a qua.rter of the applicants and selecting only the best after inquiry and examination. I am, Sir, vours faithfully. WM. ROBINSON. Sunderland, April 7th, 1927. "
CLINIC."
of THE LAXCET. SIR,-In view uf certain publicity which has recently been given to the London Clinic (founded and maintained by the British Humane Association), we, the undersigned, wish it to be known that we have severed our connexion with that body. To the Editor
We are. Sir. vours faithfullv. DAWSON OF PENN THOMAS HORDERAdvisory Committee. REGINALD C. JEWESBURY, L. D. BAILEY, J. F. CARTER BRAINE, G. MURRAY LEVICK (Hon. Medical Director), E. P. CUMBERBATCH, STANLEY MELVILLE, C. A. ROBINSON. S. L. HIGGS, D. V. HUBBLE (R.M.O.), April 8th, 1927.
chronic pancreatitis. The latter may be the explattation of the low threshold in Dr. Shapland’s case. It has long been recognised that glycosuria is a relatively uncommon result of the chronic interstitial pancreatitis associated with gall-stones and that when it occurs it is of a mild type. But the disease is usually progressive and, although operative interference may bring about an improvement ill the patient’s carbohydrate tolerance, it is often unly temporary and frank diabetes ultimately develupa. I have several patients in whom this series of events, spread over as long as ten years in one instance, has taken place and they are now being kept alive only by the use of considerable doses of insulin. While, therefore, I agree with Dr. Shapland that removal of the diseased gall-bladder in his case was probably the deciding factor in the alleviation of the diabetic condition, I should be doubtful whether the recovery will be permanent. I am, Sir, yours faithfully,
P. J. CAMMIDGE. Nottingham-place, W., April 9th, 1927.
INFLUENZA: A PERSONAL STORY. To the Editor
of
THE LANCET.
recent attack of pure influenza SIR,—During I reflected upon the field of action of the germs, or of their conflict with phagecytes. The influenza was pure" inasmuch as none of the germs which are usually loafing about the throat took part in the frolic. After breakfast I had done my chores in the garden (my gardener is free on Sunday), and returned to the house without an inkling of impending trouble. There was absolutely no symptoms ; yet unwonted disinclination to starting for church aroused suspicion. Temperature 100.6° F. Later in the day the raised temperature caused the epithelium of the throat the secrete clean white mucus, which provoked a cough. For three days I put nothing into my stomach but water and carbonate of soda, this in my personal experience being the only means of avoiding the misery of flatulent distension which results from taking food when the digestive secretions are in abeyance, and a high temperature favours It was clear that the skin, muscles, fermentation. and interstitial lymphatic tissue were not affected. During this period and the succeeding two days the clear urine was the colour of dark brown sherry. The Destruction of blood pigment was going on. liver was certainly within the field of operations. No food and a motion every day had emptied the lower bowel before, on the fifth morning, I passed a very large quantity of black inspissated bile, which had collected in the sacculi of the colon. The hæmolytic capacity of the germ may possibly afford a clue to its identity. Until I discovered that I was feverish I but was head to head with members of my family ; they escaped. This seems to show that in the earliest stage of influenza germs do not escape into the breath. I am. Sir, vours faithfullv. ALEX HILL. 1927. April 7th, a
GLYCOSURIA COMPLICATED GALL-STONES To the Editor
of
BY
THE LANCET.
SIR,—In connexion with the case described by Dr. Shapland in your last issue, may I point out that, in my experience, an abnormally low threshold for glucose is not uncommon in diabetes. The systematic chemical analysis of the whole blood made in all my cases has shown that, as a rule, this lowering of the threshold is associated with a subnormal percentage of calcium upon which it appears to depend, for the threshold rises if the percentage of calcium increases. Partial exhaustion of the parathyroids as a result of chronic toxaemia appears to be the most common cause, but, since disturbances of calcium metabolism occur in connexion with inflammatory affections of the pancreas, as I believe I was the first to point out in 1904, it may also arise as a consequence of
THE GLUT IN WOMEN DOCTORS. To the Editor
SIR,—The glut in
of
THE LANCET.
women
doctors still continues.
single advertisement inserted in a London weekly medical journal produced 48 applicants for twu posts-viz., those of senior and junior resident medical officers to a children’s hospital in the Xurth of England, the salaries being £120 and £1 00. Recently a like advertisement brought forth only 12 male A
candidates for the
post
of house
physician
at
our
general hospital. None of the former applicants gave her age as 29. Thirty-eight of the candidates had held previous hospital appointments lasting from 2 tu 50 months. Many had gone from post to post. All the applicants were University graduates except one, who held the diploma of the London Conjoint College and she is a R.M.O., in a homoeopathic hospital. Twenty-three had English qualifications. 21 Scottish, and 4 Irish (one from north Ireland and 3 from the Free State). The 23 English women had degress from Oxford 1, Durham 4, London 10 over
(University 9, Conjoint Colleges 1), Birmingham I, Liverpool 3, and Manchester 4. The 21 Scottish graduates were 3 from St. Andrews, 6 from Edinburgh, 8 from Glasgow, and 4 from Aberdeen. The Irish graduates were 1 from Belfast and 3 from Dublin. The large number of Scottish applicants were out of proportion to the numbers qualifying across the border. Of over 2000 new names added to the Medical Register last year from Great Britain, twothirds were from England and one-third from Scotland, although Scotland has only one-seventh the population of England. The Oxford graduate was appointed senior and a Durham graduate, who had local influence, junior medical officer. With regard to the excessive number of graduates (men and women) entering the profession in the face of a fallen and still falling sickness rate-the Medical Register already contains over 53,000 namesit is said that out of every three qualifying in Ireland two must emigrate, and the proportion must be higher from Scotland. The celebrated Abernethy at the first meeting of his annual class of medical students used to exclaim, " Good God. gentlemen, what will become of you all ? So we may say to-day. Some of the best American Universities (Pennsylvania, Baltimore, &c.). restrict their medical students to a fixed number, which can be adequately taught the practical side of their work, some of them admitting less than a qua.rter of the applicants and selecting only the best after inquiry and examination. I am, Sir, vours faithfully. WM. ROBINSON. Sunderland, April 7th, 1927. "