Clinicians in Chicago

A peculiarity of the Central Society for Clinical Research among medical organizers is that members prefer to let young doctors do the talking rather than to hear old doctors burble about diseases which originally earned them their reputation. Only if young clinicians lack topics do older clinicians step forward. Thus, when this medical society met in Chicago last week, young doctors were stimulated to report on the following matters:

Sugars & Fats-- Diabetes is due to improper functioning of the pancreas, a small spongy gland in the abdomen which pours certain digestive juices into the intestines. In addition, the pancreas secretes insulin, a hormone which goes directly into the blood and helps turn carbohydrates into energy. To compensate for lack of insulin production in diabetics, doctors for the past dozen years have given such patients hypodermic doses of drugstore insulin. In addition some doctors order them to take large amounts of fat with their meals, with the idea of resting an inefficient pancreas. Other doctors order large amounts of sugars and starches, with the idea of whipping up a lazy pancreas.

Last week Dr. Cyril Mitchell MacBryde, 29, of St. Louis, threw a cogent idea into this muddle. Some diabetics, found he, are that way because the pancreas does not secrete enough insulin for the body's business. Such diabetics feel better if they get fats but no starches and sugars, thus resting their weary pancreases. Another type of diabetic suffers because, even if he produces a satisfactory amount of insulin, he has some inhibiting factor in his blood which prevents that hormone from acting on carbohydrates. That class of diabetics benefit, Dr. MacBryde found, when they eat great quantities of candy, pastry, bread, potatoes, spaghetti. The excess carbohydrate does two things. It blocks the action of that inhibiting agent, and it stimulates the pancreas supply of insulin to the system. A few injections of insulin, said Dr. MacBryde, should tell the observant doctor what type of diabetic his patient is, what foods to let him have.

Cinchophen. To stimulate the excretion of uric acid and thus to remedy certain states of gout, arthritis, rheumatism, sciatica and neuralgia, doctors recently adopted a synthetic drug called cinchophen, made from quinine and carbolic acid. Soon cinchophen users complained of jaundice. Many died, and, upon autopsy, revealed extensive degeneration of the liver. Doctors nevertheless hesitated to abandon this highly useful drug.

Last week Drs. Walter Lincoln Palmer, 39, of Chicago, & Paul Silas Woodall, 27, of Montreal, said that cinchophen must go into the medical discard. Their reasons: "Very small doses given for very brief periods of time may prove fatal. Discontinuance of the drug upon the appearance of even the slightest symptoms does not ensure a favorable outcome. The first symptom usually recognized is jaundice, and withdrawal of the drug at this stage even with appropriate therapy does not prevent a fatal termination in approximately half of the cases."

Bulk in the Gut. "This is the first time the true nature of the action of bulky food in the intestines has ever been demonstrated," claimed Drs. William Harwood Olmsted, 48, & Ray D. Williams of St. Louis, in telling why they fed three medical students such bulky foods as carrots, cabbage, peas, wheat bran, alfalfa leaf, corn germ meal, cotton seed meal, sugar beet pulp, cellulose flour and agar agar. How do such bulky foods make the bowels move? Drs. Olmsted & Williams decided: "The sum and substance of this physiological experiment goes to prove that the so-called 'bulk' of the human diet is not inert material going through the intestinal tract unchanged, but rather that it is acted upon by bacteria to a very great degree, and that it is these split products of bacterial action that stimulate the gut."

Mulattoes' Hearts. Mulattoes, even if their heart arteries are stiff as clay pipes, do not complain of angina pectoris, owing simply to their "inability to correctly interpret and describe the pain sensation rather than to lack of mental stress and strain as suggested frequently in the past." Such was the finding of Drs. Emmet Field Horine, 50, & Morris M. Weiss, 34, of Louisville.

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