the lancet 100 years ago

1
1354 to hospital for the change, and 45 per cent. of his cases had no return of glycosuria during the process. The average dose of zinc protamine insulin required was slightly lower than that of soluble insulin. When the total daily dose of soluble insulin is 25 units or less the patient could be put at once on the same dose of zinc protamine insulin. When the total was greater than 25 units it was better to give three- quarters of the dose in the form of zinc protamine insulin and one-quarter in the form of soluble insulin. Of 102 carefully studied cases 77 did not require any soluble insulin after the change in the drug; 25 required a little soluble insulin to control the hyper- glycsemia following breakfast and to avoid the hypo- glycaemia which tends to occur in the afternoon or evening when large doses of zinc protamine insulin have to be given. For a new case, with moderate diabetes, 10 units of the zinc protamine preparation could be started without hesitation but any increase of the dosage should be made more slowly than with soluble insulin, about 4 days being allowed to elapse between each increase. Severe cases were better dealt with by soluble insulin at first and later the change could be made. In Prof. Dunlop’s experience the average diabetic feels better on zinc protamine insulin and he attributes this to the avoidance of hyperglycsemia. With this treatment the carbo- hydrate given should be spread equally over the principal meals. When hypoglycaemia occurs the reactions may be severe ; they are more difficult to relieve and are different in manifestation from those which occur with soluble insulin. Instead of the usual sweating, palpitation, and tremor observed, the symptoms of hypoglycsemia with the zinc preparation are slight headache, general malaise and, sometimes, nausea and vomiting. Patients must be warned, therefore, that the symptoms of too much insulin will be different with the new preparation, or else they may pass into coma without realising the cause of their ill-being. Prof. Dunlop left no doubt of his conviction that the use of zinc protamine insulin constitutes an important advance in the treatment of diabetes mellitus. IRELAND (FROM OUR OWN CORRESPONDENT) THE IRISH FREE STATE MEDICAL UNION THE annual general meeting of the Irish Free State Medical Union was held in the Royal College of Surgeons on May 2nd. In the morning a scientific session was held when a spirited discussion on the diagnosis and treatment of gastric disease was introduced by Dr. J B. Magennis and Mr. Seton Pringle. At the business session in the afternoon Dr. Conor Maguire, the president, and subsequently Dr. P. MacCarvill, the newly elected president, took the chair. The membership of the Union now stands at 955 ; 109 new members were elected during the year, 12 resigned, and 10 died. There were 23 transfers to the British Medical Association and 20 transfers from that body to the Union, consequent on changes of residence. The audited accounts showed a total income from all sources of 2635, and a total expenditure of ;t2150, leaving a balance of income over expenditure of 485, and a balance of assets over liabilities of E2886. In the discussion which followed an account of the various activities of the council during the year, the cumbrous form of the constitution of the Union was criticised, and a small committee was appointed to devise, if possible, a simpler constitution. Dis- content was expressed with the reluctance of several of the Ministers to discuss with representatives of the Union various matters concerning the welfare of the profession. There has been, as yet, no settlement of the differences between the Union and the Depart- ment of Local Government and Public Health on the question of a suitable fee for immunisation against diphtheria. At the annual general meeting last year a resolution had been passed which had tied the hands of the council, and it was decided to rescind part of that resolution so as to leave them more free to enter into negotiations. The fee so far approved by the council is about half that approved in Northern Ireland and less than half that paid at present in Great Britain. It is hoped that the diffi- culty may be solved by a general increase in the salaries of the district medical officers of health rather than by laying down a fee for each act of immunisation. The meeting ended with a dinner, attended by some 60 members and their friends at the Dolphin Hotel. ADMINISTRATION OF THE MILK AND DAIRIES ACT When the Milk and Dairies Act (1935) was under discussion in the Dail three years ago it was recog- nised that very few of the local authorities entrusted with the administration of the Act are much interested in health affairs, and that however good the legisla- tion may be it cannot be useful unless rigorously administered. Unfortunately there is evidence that these forebodings were justified and that in many- probably most-rural areas careful administration has been lacking. Moreover, in some of the few cases where prosecutions have been brought by the rural authorities the courts have shown a deplorable lenity. It is unjust to the milk-producers who have taken pains to obey the law and to produce clean milk to find that their competitors are permitted to sell dirty milk and even if convicted of the offence are only punished by the imposition of trivial fines. In his annual report on the health of his district Dr. D. F. McCarthy, medical officer of health for the North Riding of County Tipperary, remarks that if the Milk and Dairies Act were administered in a thorough and efficient manner it could do much good for the health of the nation, but the half-hearted operation of such an important piece of legislation might well leave the position worse than before the Act became law, and the public under a false sense of security. THE LANCET 100 YEARS AGO June 9th, 1838, p. 374. From a leading article on the Irish ..Jledical Oharities Bill. ... ADAM SMITH proved, a long time ago, that Govern- ments invariably do everything which they undertake worse than private individuals : and it is a remarkable fact that places under Government are the only places for which all kinds and classes of unqualified persons apply. A Fiddler would put in for an Inspectorship of Prisons under Government, a Poet for a post in the Finance department, a briefless Barrister for the-Chancellor- ship, a shallow Lord for a Colonelcy in the Guards, a Novelist for a Colonial Governorship ; one of the 26 County Surgeons, the greatest ass in all Ireland, for a place under the Medical Charities Bill: and it is evident that every one must have some chance, or why would so many put into the Official Lottery.

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Page 1: THE LANCET 100 YEARS AGO

1354

to hospital for the change, and 45 per cent. of hiscases had no return of glycosuria during the process.The average dose of zinc protamine insulin requiredwas slightly lower than that of soluble insulin. Whenthe total daily dose of soluble insulin is 25 units orless the patient could be put at once on the same doseof zinc protamine insulin. When the total was

greater than 25 units it was better to give three-quarters of the dose in the form of zinc protamineinsulin and one-quarter in the form of soluble insulin.Of 102 carefully studied cases 77 did not require anysoluble insulin after the change in the drug; 25

required a little soluble insulin to control the hyper-glycsemia following breakfast and to avoid the hypo-glycaemia which tends to occur in the afternoonor evening when large doses of zinc protamine insulinhave to be given. For a new case, with moderatediabetes, 10 units of the zinc protamine preparationcould be started without hesitation but any increaseof the dosage should be made more slowly than withsoluble insulin, about 4 days being allowed to elapsebetween each increase. Severe cases were betterdealt with by soluble insulin at first and later the

change could be made. In Prof. Dunlop’s experiencethe average diabetic feels better on zinc protamineinsulin and he attributes this to the avoidance of

hyperglycsemia. With this treatment the carbo-

hydrate given should be spread equally over the

principal meals. When hypoglycaemia occurs thereactions may be severe ; they are more difficult torelieve and are different in manifestation from thosewhich occur with soluble insulin. Instead of theusual sweating, palpitation, and tremor observed, thesymptoms of hypoglycsemia with the zinc preparationare slight headache, general malaise and, sometimes,nausea and vomiting. Patients must be warned,therefore, that the symptoms of too much insulinwill be different with the new preparation, or elsethey may pass into coma without realising the causeof their ill-being.

Prof. Dunlop left no doubt of his conviction thatthe use of zinc protamine insulin constitutes an

important advance in the treatment of diabetesmellitus.

IRELAND

(FROM OUR OWN CORRESPONDENT)

THE IRISH FREE STATE MEDICAL UNION

THE annual general meeting of the Irish FreeState Medical Union was held in the Royal Collegeof Surgeons on May 2nd. In the morning a scientificsession was held when a spirited discussion on thediagnosis and treatment of gastric disease was

introduced by Dr. J B. Magennis and Mr. Seton

Pringle. At the business session in the afternoonDr. Conor Maguire, the president, and subsequentlyDr. P. MacCarvill, the newly elected president, tookthe chair. The membership of the Union now standsat 955 ; 109 new members were elected duringthe year, 12 resigned, and 10 died. There were23 transfers to the British Medical Association and20 transfers from that body to the Union, consequenton changes of residence. The audited accountsshowed a total income from all sources of 2635, anda total expenditure of ;t2150, leaving a balance ofincome over expenditure of 485, and a balance ofassets over liabilities of E2886.

In the discussion which followed an account ofthe various activities of the council during the year,the cumbrous form of the constitution of the Union

was criticised, and a small committee was appointedto devise, if possible, a simpler constitution. Dis-content was expressed with the reluctance of severalof the Ministers to discuss with representatives of theUnion various matters concerning the welfare of theprofession. There has been, as yet, no settlementof the differences between the Union and the Depart-ment of Local Government and Public Health onthe question of a suitable fee for immunisation

against diphtheria. At the annual general meetinglast year a resolution had been passed which hadtied the hands of the council, and it was decided torescind part of that resolution so as to leave themmore free to enter into negotiations. The fee so far

approved by the council is about half that approvedin Northern Ireland and less than half that paid atpresent in Great Britain. It is hoped that the diffi-culty may be solved by a general increase in thesalaries of the district medical officers of healthrather than by laying down a fee for each act ofimmunisation. The meeting ended with a dinner,attended by some 60 members and their friends atthe Dolphin Hotel.

ADMINISTRATION OF THE MILK AND DAIRIES ACT

When the Milk and Dairies Act (1935) was underdiscussion in the Dail three years ago it was recog-nised that very few of the local authorities entrustedwith the administration of the Act are much interestedin health affairs, and that however good the legisla-tion may be it cannot be useful unless rigorouslyadministered. Unfortunately there is evidence thatthese forebodings were justified and that in many-probably most-rural areas careful administrationhas been lacking. Moreover, in some of the fewcases where prosecutions have been brought by therural authorities the courts have shown a deplorablelenity. It is unjust to the milk-producers who havetaken pains to obey the law and to produce cleanmilk to find that their competitors are permitted tosell dirty milk and even if convicted of the offenceare only punished by the imposition of trivial fines.In his annual report on the health of his districtDr. D. F. McCarthy, medical officer of health for theNorth Riding of County Tipperary, remarks that ifthe Milk and Dairies Act were administered in a

thorough and efficient manner it could do much goodfor the health of the nation, but the half-heartedoperation of such an important piece of legislationmight well leave the position worse than before theAct became law, and the public under a false senseof security.

THE LANCET 100 YEARS AGO

June 9th, 1838, p. 374.From a leading article on the Irish ..Jledical Oharities

Bill.

... ADAM SMITH proved, a long time ago, that Govern-ments invariably do everything which they undertakeworse than private individuals : and it is a remarkablefact that places under Government are the only placesfor which all kinds and classes of unqualified personsapply. A Fiddler would put in for an Inspectorshipof Prisons under Government, a Poet for a post in theFinance department, a briefless Barrister for the-Chancellor-ship, a shallow Lord for a Colonelcy in the Guards, aNovelist for a Colonial Governorship ; one of the 26 CountySurgeons, the greatest ass in all Ireland, for a place underthe Medical Charities Bill: and it is evident that everyone must have some chance, or why would so many putinto the Official Lottery.