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THE INTERNECINE VENEREAL CAMPAIGN.
989 condonation but also lead to’the assumption that such dis-’ infectants are an official guarantee to the purchaser against contracting disease; moreover, such instructions, unless followed with scrupulous exactness after definite and personal tuition in their practice, may lead to an aggravation rather than a diminution of the incidence of these diseases." Nevertheless, these sentences express not merely the truth, but the truth which is daily receiving greater recognition, and I have no doubt whatever, that even in spite of suppression and misrepresentation, truth will continue to prevail. I am even hopeful that Lord Willoughby de Broke, who has been frank and courteous throughout all our conversations, when allowed to speak through his own voice, will find the courage to shake himself free of the influences which are alone keeping the schism open, and so enable it to be harmoniously closed, to the great advantage of the campaign which we both have sincerely at heart. I am, Sir, vours faithfully,
Correspondence. "
THE
Audi alteram p&rten."
OF A TRADE-UNION IN MEDICINE. To the Editor of THE LANCET.
QUESTION
SIR,—Every right-minded practitioner must agree that a strike among medical men, involving the neglect of patients, is unthinkable. But there is another aspect of the subject which has, perhaps, been overlooked. Doctors are a State-protected body, and, that being so, have they the moral right to use the strike weapon ? The police are not allowed to use it, and if the miners were to get their wish-State protection-the right to strike would have eventually to be taken from them. Eventually, for no Conservative, Liberal, or Coalition GORELL, Government would be likely to pass such a measure ; President, National Council for Combating Venereal Diseases. but when the Labour Government comes it will probably find itself obliged to do so. Russia has already *** From an implied personality in this letter two found the necessity of such legislation. Would it not refiections may arise. First, it is an assumption be a pity to have to wait for a Labour Government to that "Our Medical Correspondent" in a lay paper is teach us the difference between right and wrong? an individual. Secondly, a "correspondent" does I am. Sir. vours faithfullv, not dictate the editorial policy of a journal.-ED. L. W. D. ANDERSON.
THE TREATMENT OF DIABETES MELLITUS To the Editor of THE LANCET.
THE INTERNECINE VENEREAL CAMPAIGN. To the Editor
SIR,-I have
of THE LANCET.
studiously
abstained from controversy and have for several months past, as letters in my possession prove, been engaged in frank and friendly discussion both with Lord Willoughby de Broke, and other members of his Society, in an endeavour to end the schism that is doing much harm to the warfare against venereal diseases. I feel bound now to point out to the public that two things only hinder the progress of negotiations. First the sending of letters to the press by the same post as that by which they have been sent to me-a discourtesy which has twice taken place and makes frankness impossible ; and secondly, and more seriously, the undeviating way in which the Times has given publicity to Lord Willoughby de Broke’s Society, and suppressed-or most misleadingly summarisedthe attitude of the National Council. An instance of its partiality occurred on the publication of the report of the Bishop of Birmingham’s Committee. This was at once described by the Times as the case of the Society for the Prevention of Venereal Disease, a parenthetical comment which the most prominent member of that Society admitted to me to be incorrect. An even worse instance has just occurred. The Times has quoted at length from a letter sent to me by Lord Willoughby de Broke, and has not quotedand has never done other than very briefiy and misleadingly summarised-the definition of the National Council’s policy to which Lord Willoughby de Broke’s letter was in reply. It has refused to publish the letter I at once wrote, even though I was drawing attention to action for which Lord Willoughby de Broke has subsequently expressed full and frank regret. It is time that the public understood the reason ; no one can be impartial on a matter he has already prejudged, and the "Medical Correspondent " of the Tim.es who comes before the public anonymously as an impartial commentator is a member of Lord Willoughby de Broke’s Executive Committee. In these circumstances, I ask permission to state in your columns what I am refused permission to state in the 2’MMes—namely, that between the policy of the National Council, as defined at our general meeting onI March 22nd, 1921, and that of Lord Willoughby de Broke’s Society, there is now admitted to be but real point of difference ; that lies in the inability of( the latter to accept the following sentences of our’, definition of policy :! " Detailed official instructions as to the use of disinfectants in this connexion will, if issued to the public on sale with I the disinfectants, not only have an appearance of I
one’I
official
" Be not the first by whom the new is tried, Nor yet the last to cast the old aside."
S1R.,-Pope’s advice practitioner. practitioner not to be
may be taken to apply to the This letter is a plea to every the last to cast aside the old treatment of diabetes mellitus by continuing to prescribe a diet of unlimited protein and fat. It is no easy matter to decide whether fat or protein in unlimited quantities is the more injurious, although there is little doubt that excessive fat ushers the young patient into the next world more rapidly than excessive protein, by causing an early and often fatal acidosis. Unlimited or excessive protein is more insidious in its action. The patient does not die rapidly, but the disease advances rapidly and a stage is reached in which the changes in the pancreas are so profound that treatment by alimentary rest and under-nutrition is rendered nugatory. The observations upon which statements are made should always accompany these statements. Shortly after adopting the Allen treatment of diabetes mellitus in 1915, I found that the cases which reacted best to the treatment were comparatively young people who had developed the disease recently, and that those, who had been treated by the so-called Pavy treatment for months or years had very low tolerance for food in general; that is to say, that unless the amount of the carbohydrate, protein, and fat in the diet was very small, sugar persisted in the urine, the blood sugar was over 0’18 per cent., and the disease progressed. Still further, one received the impression that the patients who had adhered most strictly to the orders of their medical advisers to refrain from any food containing carbohydrate, and had taken large quantities of breads and biscuits made with protein, were the most refractory to treatment. Clinical observation anticipated experimental evidence. Allenrecorded his observations upon dogs of the results produced by protein excess. He removed six-sevenths of the pancreas from a dog ; for three days there was glycosuria without feeding. Upon a meat diet there was a heavy continuous glycosuria, and when this diet was maintained for some time it led to a condition which did not yield to a nine days’ fast. Since the same observer has kept dogs alive for six years with no greater proportions of pancreas he concludes that " the downward progress observed in animals on excessive diets is purely the result of food injury; in other words, to functional over-stimulation of the pancreas as an endocrine organ." It is therefore medical
1
The Journal of Experimental Medicine, May 1st, 1920.
Correspondence. "
THE
Audi alteram p&rten."
OF A TRADE-UNION IN MEDICINE. To the Editor of THE LANCET.
QUESTION
SIR,—Every right-minded practitioner must agree that a strike among medical men, involving the neglect of patients, is unthinkable. But there is another aspect of the subject which has, perhaps, been overlooked. Doctors are a State-protected body, and, that being so, have they the moral right to use the strike weapon ? The police are not allowed to use it, and if the miners were to get their wish-State protection-the right to strike would have eventually to be taken from them. Eventually, for no Conservative, Liberal, or Coalition GORELL, Government would be likely to pass such a measure ; President, National Council for Combating Venereal Diseases. but when the Labour Government comes it will probably find itself obliged to do so. Russia has already *** From an implied personality in this letter two found the necessity of such legislation. Would it not refiections may arise. First, it is an assumption be a pity to have to wait for a Labour Government to that "Our Medical Correspondent" in a lay paper is teach us the difference between right and wrong? an individual. Secondly, a "correspondent" does I am. Sir. vours faithfullv, not dictate the editorial policy of a journal.-ED. L. W. D. ANDERSON.
THE TREATMENT OF DIABETES MELLITUS To the Editor of THE LANCET.
THE INTERNECINE VENEREAL CAMPAIGN. To the Editor
SIR,-I have
of THE LANCET.
studiously
abstained from controversy and have for several months past, as letters in my possession prove, been engaged in frank and friendly discussion both with Lord Willoughby de Broke, and other members of his Society, in an endeavour to end the schism that is doing much harm to the warfare against venereal diseases. I feel bound now to point out to the public that two things only hinder the progress of negotiations. First the sending of letters to the press by the same post as that by which they have been sent to me-a discourtesy which has twice taken place and makes frankness impossible ; and secondly, and more seriously, the undeviating way in which the Times has given publicity to Lord Willoughby de Broke’s Society, and suppressed-or most misleadingly summarisedthe attitude of the National Council. An instance of its partiality occurred on the publication of the report of the Bishop of Birmingham’s Committee. This was at once described by the Times as the case of the Society for the Prevention of Venereal Disease, a parenthetical comment which the most prominent member of that Society admitted to me to be incorrect. An even worse instance has just occurred. The Times has quoted at length from a letter sent to me by Lord Willoughby de Broke, and has not quotedand has never done other than very briefiy and misleadingly summarised-the definition of the National Council’s policy to which Lord Willoughby de Broke’s letter was in reply. It has refused to publish the letter I at once wrote, even though I was drawing attention to action for which Lord Willoughby de Broke has subsequently expressed full and frank regret. It is time that the public understood the reason ; no one can be impartial on a matter he has already prejudged, and the "Medical Correspondent " of the Tim.es who comes before the public anonymously as an impartial commentator is a member of Lord Willoughby de Broke’s Executive Committee. In these circumstances, I ask permission to state in your columns what I am refused permission to state in the 2’MMes—namely, that between the policy of the National Council, as defined at our general meeting onI March 22nd, 1921, and that of Lord Willoughby de Broke’s Society, there is now admitted to be but real point of difference ; that lies in the inability of( the latter to accept the following sentences of our’, definition of policy :! " Detailed official instructions as to the use of disinfectants in this connexion will, if issued to the public on sale with I the disinfectants, not only have an appearance of I
one’I
official
" Be not the first by whom the new is tried, Nor yet the last to cast the old aside."
S1R.,-Pope’s advice practitioner. practitioner not to be
may be taken to apply to the This letter is a plea to every the last to cast aside the old treatment of diabetes mellitus by continuing to prescribe a diet of unlimited protein and fat. It is no easy matter to decide whether fat or protein in unlimited quantities is the more injurious, although there is little doubt that excessive fat ushers the young patient into the next world more rapidly than excessive protein, by causing an early and often fatal acidosis. Unlimited or excessive protein is more insidious in its action. The patient does not die rapidly, but the disease advances rapidly and a stage is reached in which the changes in the pancreas are so profound that treatment by alimentary rest and under-nutrition is rendered nugatory. The observations upon which statements are made should always accompany these statements. Shortly after adopting the Allen treatment of diabetes mellitus in 1915, I found that the cases which reacted best to the treatment were comparatively young people who had developed the disease recently, and that those, who had been treated by the so-called Pavy treatment for months or years had very low tolerance for food in general; that is to say, that unless the amount of the carbohydrate, protein, and fat in the diet was very small, sugar persisted in the urine, the blood sugar was over 0’18 per cent., and the disease progressed. Still further, one received the impression that the patients who had adhered most strictly to the orders of their medical advisers to refrain from any food containing carbohydrate, and had taken large quantities of breads and biscuits made with protein, were the most refractory to treatment. Clinical observation anticipated experimental evidence. Allenrecorded his observations upon dogs of the results produced by protein excess. He removed six-sevenths of the pancreas from a dog ; for three days there was glycosuria without feeding. Upon a meat diet there was a heavy continuous glycosuria, and when this diet was maintained for some time it led to a condition which did not yield to a nine days’ fast. Since the same observer has kept dogs alive for six years with no greater proportions of pancreas he concludes that " the downward progress observed in animals on excessive diets is purely the result of food injury; in other words, to functional over-stimulation of the pancreas as an endocrine organ." It is therefore medical
1
The Journal of Experimental Medicine, May 1st, 1920.