CHAPTER 7

Diabetes

Diabetes Cure Confirmed by Treatment of 176 Cases

A great deal has been written and published in both the medical and lay press in recent years relative to the merits of the Bacillus bulgaricus as a therapeutic agent. Milk seems to be the normal habitat of this micro-organism. Remarkable instances of longevity among those European and Asiatic nations which, to use Kipling’s expression, are the “most easterly of Western peoples and the most westerly of Eastern peoples,” have been ascribed to the habitual and long-continued consumption of preparations of sour milk, under various names, which contain this non-pathogenic germ.

Some scientists “swear by” the B. bulgaricus. Prof. Elie Metchnikoff, the distinguished laboratory worker and medical investigator, is one of them. This harmless bacterium, if it had had its rights in times past and the science of bacteriology had been sufficiently developed, undoubtedly would have been incorporated in Brown-Séquard’s “Elixir of Life”; if it had found a resting place in Ponce de León’s spring and flourished there, that undiscoverable but highly desirable fountain of youth would be as well marked today, geographically speaking, as the Egyptian Sphinx and as consistently visited as Mecca itself.

A Good Therapeutic Agent

The Bacillus bulgaricus is now a highly valued therapeutic agent, and after close observation and its employment as a remedial agent for more than a year it has been demonstrated that not only can severe cases of diabetes mellitus be checked and held in control by it, but that it will cure moderate cases. It is also believed by Dr. J. Wallace Beveridge of this city, who has contributed a comprehensive article on the treatment of this disease with cultures of the bacillus to the last two issues of the New York Medical Journal, that this common and dreaded ailment, which formerly was usually considered a fatal malady by the medical profession, can be prevented by the early use of the cultures in cases of intestinal putrefaction when this condition is recognized.

The first announcement in the lay press of the value of cultures of this bacillus in diabetes appeared in The Times last year and was based on information derived from Dr. Beveridge’s observations. His present report is the result of treating 176 patients, who were suffering from well-defined diabetes, with cultures of this bacillus. In addition to giving exact statistical reports of several of his cases, Dr. Beveridge furnishes a number of facts concerning the cause of diabetes that are original, and also introduces for the first time in connection with the diagnosis of the ailment X-ray pictures indicating the intestinal conditions that are factors in the etiology of the disease.

The facts relating to faulty digestion and mechanical intestinal derangement as causative of diabetes, considered in conjunction with another set of facts brought out by another New York physician, Dr. I. L. Nascher, in an article on “Longevity and Rejuvenescence” printed in the New York Medical Journal on the same date that the first section of Dr. Beveridge’s article appeared, constitute a startling arraignment of one of the apparently necessary contingents of modern civilization—cold-storage foods. Dr. Nascher says that cold-storage foods rapidly decompose in the stomach and intestines. Dr. Beveridge asserts that this rapid decomposition is largely responsible for diabetes. When asked about Dr. Nascher’s declaration, Dr. Beveridge indorsed his views, and immediately declared that the present-day prevalence of diabetes—possibly one person in every fifteen more than 40 years old is attacked by it—was due undoubtedly to the enforced consumption of cold-storage foods in the larger centres of population. Neither physician, however, offers a solution of the cold-storage problem.

Dr. Nascher quotes from the report of the Field Secretary of the Provident Life Assurance Society of England to the effect that the death rate from diseases of the heart, kidneys, and circulatory system, including apoplexy, has increased 105 per cent, in the United States since 1880, while in England the increase in deaths from these diseases during this period was only 3 per cent. He attributes the increase in this country largely to the “strenuous life.”

Results Not Final

The distinguishing characteristic of diabetes mellitus is the presence of sugar in the secretion of the kidneys. This condition is known as glycosuria. The value of any therapeutic agent used in the treatment of diabetes is measured by its power to lower the sugar index. It is just a year ago since Dr. Beveridge said:

“In fact, in eleven cases so far treated that have been under constant care a sufficient length of time, and where the sugar index is now absent, the cure has been complete, and if the patients every now and then submit to an examination and, if necessary, resume medication for a short period, I believe that they will remain in the normal state regained through this new treatment.”

“In presenting a new therapeutic measure for the treatment of diabetes,” says Dr. Beveridge in the present report, “great caution should be maintained toward an optimistic viewpoint until a sufficient number of positive recoveries are noted, which would warrant an assertion that such a procedure as that herein recorded is of true value. The results in the 176 cases cited, and observations made by Dr. George P. Klemann and myself in this preliminary report, should in no way be considered as final.”

The author gives a brief outline of the main etiological factors of the disease in order to sustain his argument, which theoretically indicates the employment of B. bulgaricus as the rational treatment. From this it appears that “the pancreas is the gland where secretion is known to have the most power in breaking down the carbohydrate group.”

Carbohydrates are the sugars and starches, and are substances containing carbon, hydrogen, and oxygen, the two latter in the proportion to form water. When the carbohydrates are broken down by the internal secretions they split up into a variety of substances whose names are immaterial for the purposes of this article. As Dr. Beveridge explains, the most important carbohydrate as a food is starch, but, as such, is valueless, though easily broken down by the digestive ferments. The saliva and pancreatic juice contain a ferment which changes starch into maltose.

“During digestion,” says the author, “the activity of the pancreatic secretion depends mostly upon the acidity in the duodenum and small intestine, this acidity causing a peripheral, local stimulating reflex action on the ganglionic cells scattered throughout the pancreas, while the reflexes of central origin remain inert.

Results of Research

“Popielski, Wertheimer, and Le Page demonstrated that when an acid was introduced into the duodenum, pancreatic secretion was excited, and they were able to prove that pancreatic secretion could be induced by the injection of acid into the small intestine, the effect diminishing as the acid neared the lower end of the intestine. The name of the product formed inducing pancreatic activity is known as ‘secretin.’ Bayliss and Starling confirmed the results given above and justify the statement that ‘when the acid gastric juice of digestion reaches the duodenum the prosecretin manufactured by the epithelial cells is converted into secretin, which is immediately absorbed into the blood stream, then carried to the cells of the pancreas, which at once are stimulated to secretory activity.’

“The process showing the power exerted through the stimulation of acid digestion in producing secretin, so necessary to the normal functionating of the pancreas, has never until now been brought forward as a factor in glycosuria. Hence, one can readily perceive that when chronic conditions arise to change the acidity of the gastric contents, a corresponding response will be noted in the production of secretin.

“According as a hyperacidity (increased acidity) or hypoacidity (lowered acidity) of the gastric chyle is apparent while passing through the duodenum and upper portion of the small intestine, the amount of secretin manufactured is either increased or diminished, and, reflexly, the pancreatic secretions will also be increased or diminished. Should this abnormal chemical reaction continue, whereby the pancreas receives inadequate stimulation during digestion, serious chemical and metabolic changes will in time manifest themselves, which may eventually combine and prevent complete carbohydrate metabolism.

“The other causes interfering with a normal production of secretin are intestinal putrefaction, ulcer of the duodenum or pylorus, and any lesion involving the mucosa of the duodenum and upper portion of the small intestine.

“The liver, next to the pancreas, furnishes the most important etiological factor, but in this paper a complete exposition of its action in digestion is impossible. Only a very brief indication of a few cardinal points will be undertaken. The power of the liver cell to change ammonia into urea is vital. When any abnormal cellular change manifests itself the urea content is lessened and the ammonia output increased.

“This fact is observed in all severe eases of diabetes, in anaemias, in some types of intestinal nephritis, in toxaemias, in hypertrophic and atrophic cirrhosis of the liver, in chronic inflammations of the gall duct, and in malignancy. A continued low urea output is an unfavorable sign in diabetes. Generally, we find that when the liver is unable to normally change ammonia into urea the secretion of the bile is affected, the production is lessened, and the bactericidal action diminished.

“The intestinal tract also plays a most important part in carbohydrate metabolism. In more than 90 per cent of the cases under observation there was intestinal putrefaction, usually traced to chronic constipation, intestinal stasis, or lack of proper bodily care. The normal action of digestion is dependent upon the daily intestinal elimination and non-absorption of the waste products; otherwise interference with oxidation, as a result of auto-intoxication, will co-ordinately affect the entire internal secreting glandular system, and, should such a chronic state ensue, cellular changes in the thyroid, pituitary, and pancreas ofttimes begin. Of course, constipation is the main cause of all intestinal disturbances, and to-day we can be reasonably certain whether a chemical or mechanical derangement is paramount.

“The chemical faults may be ascribed primarily to improper food, such as food of poor quality, food badly prepared, or unbalanced food consisting either of carbohydrates or proteids in excess; interference with the chemical activating agents of peristalsis, i.e. bile &c., and the noxious chemical products of intestinal putrefaction, come under this heading.

“The mechanical faults are demonstrated by the radiograph, briefly indicated from observations made by Dr. A. J. Quimby, Professor of Radiography at the New York Polyclinic Medical School, on some 350 patients and upon cases submitted by me, in which the patient’s stomach and intestines have been radiographed following a test meal of bismuth. In this series the mechanical defects portrayed were frequently marked, and the data obtained through this accurate determination of the stomach and intestines have proved most valuable, especially in the prognosis and treatment.”

Dr. Beveridge then describes the different mechanical faults that interfere with normal digestive processes, as revealed by the X-ray plates, and continues:

“The preceding facts readily demonstrate why glycosuria often follows a grave cellular change in the pancreas, liver, or small intestine; so that we now know that a chemical fault or a mechanical one, or both combined, is always necessary for a diabetic state to manifest itself.”

This interesting information concerning the discovery of the Bacillus bulgaricus is recorded:

Who Deserves Credit?

“Much controversy has arisen, since the international employment of the Bacillus bulgaricus culture for intestinal putrefaction, as to whom the credit should belong for first isolating this organism. It seems that Prof. Kern, in 1881, first published an article describing the micro-organisms found in Russian kefir. At this early period the bacteriological technique was perhaps untrustworthy for accurate information, and judgment should therefore be withheld on the question whether the true Bacillus bulgaricus of to-day was isolated at that time. Beijerinck unquestionably was the first to positively demonstrate the isolation of the Bacillus caucasicus, which belongs to the bulgaricus group.

“Two distinct classes of this organism have been demonstrated, and the first investigators to prove this fact were Rist and Khoury. A true bacillus isolated from the Bulgarian yoghurt by Grigoroff, a member of Prof. Massol’s laboratory staff, and first described by him as the Bacillus bulgaricus, is the organism now used as a therapeutic agent.

“A further point of interest is the report by Heinemann and Hefferan that they were able to isolate this bacillus from many sources, asserting they found a bacillus identical to that of the bulgaricus in a great variety of sour and aromatic foods, in the human saliva, in the normal gastric juice, and in the gastric juice when hydrochloric acid is absent in the fermented milk and ordinary sweet milk. Cohendy devised the present media for active growth.”

The writer goes on to describe the morphological characteristics of the bacillus, the methods of cultivation, and the microscopic appearance of the cultures of both classes. Experimentation has shown that these cultures act on the carbohydrates in a manner similar to the ferments of normal digestive activity.

“The Bacillus bulgaricus,” Dr. Beveridge continues, “is non-pathogenic to man or the usual laboratory animals. No untoward effects have been observed following the ingestion of large amounts of this culture.

“The cultures of the Bacillus bulgaricus employed by me are grown upon a modified Cohendy medium, which from time to time I have had examined in reference to the purity and viability of the organism by the Gram positive method, the average count being 285,000,000+ positive per cubic centimeter, with an acid activity of from 1 to 3.6 per cent, in twenty-four hours upon sweet milk.

“In the preceding description of the Bacillus bulgaricus its action upon sugar, with the formation of lactic acid, is indicated. In diabetes the carbohydrate radicle is attacked in the intestinal tract by this bacillus and converted into lactic acid. The necessity for starch as a food is well known, and if digestion is unable to break down the molecules of starch, in glycosurias it is harmful. But by this action of the Bacillus bulgaricus this much needed carbohydrate may be taken with little, if any, excess of sugar appearing.

An Important Reaction

“This chemical reaction is of great importance when the normal combustion of sugar in the alimentary tract is at fault, and if we are able to continue the use of an active culture aid is given the pancreas, and liver to complete the carbohydrate digestion. When the pancreas receives weak stimulation by the lack of a normal quantity of secretin forming, as a result of a low gastric acidity, the potency of this bacillus to make lactic acid is of value in further stimulating the duodenum and upper portion of the small intestine.

“The antiseptic and corrective power of the bacillus, by overcoming auto-intoxication and all conditions of intestinal putrefaction, is very marked. Its distinct action in attacking the hosts of intestinal flora and the chemical action of the lactic acid upon the waste products such as indol, skatol, zanthin, and hyper-zanthin, may possess, according to Prof. Belonowsky, a still greater cleansing influence by an active product created during the proliferation of the bacillus. He positively asserts that this substance continues exercising a protective influence against reabsorption. The action of this culture is never manifested unless the micro-organisms are viable when administered.”

Dr. Beveridge goes on to give the histories of a dozen patients treated, together with detailed tables of the laboratory findings in each case. Some of these patients were discharged as cured, while others improved.

Continuing, the author says:

“The patients under observation might be divided into two great classes: the glycosurias without acidosis, and the glycosurias with acidosis. (Acidosis is a condition in which an excess of acid products is excreted.)

“Glycosuria without Acidosis (First Class). During the early period or onset there may be a total absence of any classical sign which would direct either the patient’s or the physician’s attention to a beginning of glycosuria, unless, perhaps, discovered by an insurance examination. These cases may go for a considerable length of time without noticing any untoward symptoms, possibly complain a little of constipation, heartburn, or indigestion after eating. Then, as the disease progresses, a severe shock, such as worry, exposure, overindulgence or a rheumatic attack, will cause the first unpleasant symptoms to appear, which are generally described as weakness in the legs, cramps in the calves and knees, loss of weight, polyuria of varying intensity, constipation, indigestion, headache, impaired vision and hearing, dryness of the skin, with brittleness of the finger nails and falling out of the hair. These symptoms may gradually increase in severity, while in others the tolerance for considerable quantities of sugar is acquired with the subsequent abatement in many of the unpleasant physiological reactions. The patients who do poorly are the ones which lose weight rapidly, and the sugar index conditions above 5 per cent. Such cases should he placed under strict observation, and a special effort made to prevent the loss of weight and the continued excessive production of sugar; otherwise, at any moment, a severe acidosis with coma may involve the patient.

The Second Class

“Glycosuria with Acidosis (Second Class) should be classified, for convenience, into three stages, those with acetone, those with a trace of acetone and diacetic acid, and those with marked acetone and diacetic acid, a condition always accompanied by the production of beta oxybutyric acid. The symptoms in this class are similar to glycosuria with acidosis, but the increasing weakness and malaise are more pronounced. One symptom always present is drowsiness, while vertigo and headache, if accompanied by other indications of digestive disturbance, such as vomiting, obstinate constipation and severe heartburn, or by acute gastritis, are always forerunners of grave sequalae which often end in coma. If seen before the disease has advanced to a degree in which the involvement and systemic changes have become so great that nothing can be done, patients will, as a rule, readily improve under treatment. The cases observed range from 9 to 74 years in age, and include glycosurias from those with very small amounts of sugar up to the most severe types of acidosis with dropsical effusion.

“The treatment of diabetes requires more time and consideration on the part of the physician than most diseases that come under his care. The difficulty of keeping the patient upon a strict diet and making him understand the necessity for following any good therapeutic procedure is almost insurmountable, because the moment diabetic patients begin to feel an improvement or notice the symptoms disappearing, the desire to eat forbidden food and do things that are inadvisable seems to overcome their better judgment, and they submit to these inordinate desires.

“The cases under observation are divided, as already indicated, into two classes. The first class presents the widest field for scientific work, especially by preventing this disease from a progressive development. Chronic constipation with intestinal putrefaction is the major difficulty encountered requiring correction, and a systematic examination should be undertaken to determine whether the intestinal tract, through a mechanical fault or a chemical derangement during digestion, is responsible for the condition.

“Knowing the fault causing intestinal putrefaction, our efforts are then directed toward giving relief. Should this condition be due to gastric or liver inactivity, the usual, accepted drugs are given, with from four to six tubes (equal to twelve or eighteen centimeters) of the bulgaricus culture each day. The action by this culture, as shown, begins at once to stop intestinal putrefaction. The culture is continued until an indican-tree secretion has persisted for five weeks, then the culture is gradually diminished until one tube (three cubic centimeters) every other day suffices. Not until every trace of sugar has been absent for a period of three months do we entirely discontinue using the culture.

“The mechanical defects, unless very serious, may be greatly aided by abdominal exercises, daily massage, and the galvanic treatment.

“It is necessary to ascertain in the very beginning what the carbohydrate tolerance of each patient may be, and then, by a gradual increase of starch in the daily diet we find exactly what the capacity for the daily production of sugar during the twenty-four-hour elimination is. If the carbohydrate tolerance is fairly high, and the percentage of sugar indicated in the urine analysis moderate, a liberal diet is permitted.”

The author outlines the diabetic diet, but space does not permit its repetition here.

“Those patients,” he continues, “whose pancreas, liver, or small intestine is not seriously damaged by a chronic lesion will recover. Every case, in this series, of glycosuria without acidosis has responded to the treatment described, and all the symptoms of discomfort have permanently subsided.”

If the patient has a secondary anaemia, sodium cacodylate is given every third day by subcutaneous injection.

“When acetone bodies form as a complication to glycosuria,” the report continues, “the beginning of a more serious condition is indicated, and our efforts should be directed toward overcoming this evil chemical derangement. If the patient is under control and follows suggestions made, acidosis is preventable. The abolishing of carbohydrates from the diet is one of the principal factors in the cause of acidosis. We may be able to greatly diminish the percentage of sugar, but by so doing the changed metabolism of the cell, owing to the absence of carbohydrates, increases the possibility of acidosis. Should acidosis be present we place the patient upon a fluid diet, insisting on milk, clear broths, and fruit juice, suggesting that he remain in bed during this interval for about three weeks. A culture of Bacillus bulgaricus is given up to 24 cubic centimeters per day.”

The administration of other therapeutic agents is described but must be omitted here, with the exception of mention of the fact that glandular extracts are given to patients inclined toward obesity. The cases treated as indicated above responded favorably, losing all signs of acidosis, unless the disease had advanced to such an extent that there was marked emaciation and changes in the viscera. In these cases, medication was without avail.

“In cases of the first class,” says the report, “the symptoms entirely subsided during treatment. Only seven still have traces of sugar, and if they are kept under observation from time to time, I believe will remain in a fairly normal state.”

His Conclusions

“In cases of the second class, the results have not been so marked, although all the patients have shown considerable improvement, with most of the major symptoms disappearing. The gain in weight has averaged from three to eighteen and a half pounds. The proportion of recoveries, however, is very small, and out of seventy-nine cases of acidosis we would say that five have recovered, twenty-seven have apparently been greatly benefited; the rest, with the exception of two, remaining about the same as when first observed. These two patients, both under 15 years of age, have since passed away.”

These are the author’s conclusions:

“1. The efficacy of this culture in diabetes is undoubtedly due to its power to prevent intestinal putrefaction.

“2. The stimulating effect upon the pancreas by its acidity is potent.

“3. Its power to convert starch into lactic acid is an important factor.

“4. By relieving auto-intoxication many of the symptoms in diabetes are stopped.

“5. The use of the X-ray in diagnosis is most valuable.

“6. The necessary analysis of the gastric contents should be made, so that a consistent method may be followed in treatment.

“7. The routine examination of the blood, not only for acetone, but sugar, is advisable.

“8. The prevention of this disease and the overcoming of its progress is unquestionably possible, and I believe by systematic, thorough care of all glycosurias in the first class a permanent recovery will be the reward.

“9. Glycosurias of the second class do not apparently respond, although their condition seems to be greatly benefited.

“10. The use of this culture in diabetes is far superior to that of opium, and offers the only rational internal therapy really of value.”

July 20, 1913

Diabetes Discovery Not a Positive Cure

An announcement from Cleveland, printed here yesterday, that a cure for diabetes had been discovered at the Rockefeller Institute for Medical Research, and that it had been tried successfully at the Lakeside Hospital in Cleveland, aroused much interest in medical circles yesterday. It was learned that the new treatment for the disease had been tried at the Presbyterian Hospital here with excellent results.

The discovery is at present only a new treatment, according to the New York physicians familiar with it, and cannot be called a cure, at least until there has been sufficient time to ascertain whether the disease will return after the patient has been discharged from a hospital.

The treatment was developed by Dr. Allen of the Rockefeller Institute, and before it was tried on patients he got good results with experiments on animals. It is remarkably simple, and consists almost entirely of starving out the disease. In this it is only a development of the treatment that has long been used. The most generally adopted treatment consists of eliminating carbohydrates, or foods containing starch, from the patient’s diet, and allowing the patient practically a normal supply of fats and proteins. Dr. Allen’s method eliminates the carbohydrates, but also reduces all other diet as much as the patient can stand.

The treatment calls for absolute fasting of the patient at stipulated periods. In some cases alcohol is given during the early stages. This is a new feature, though the alcohol is given to stimulate the patient and make up for the lack of food at first to some extent.

The policy of giving the patient bicarbonate of sodium to neutralize the effect of acids is adhered to in the new treatment, one of the physicians said yesterday, though it is considered questionable whether this has much to do with the results obtained. Bicarbonate of sodium has been administered in cases of diabetes for nearly thirty years. It is given in cases where there is sufficient poisoning in the system to cause nervous disorders, such as coma and fainting.

Despite its simplicity the new treatment has been producing results considered almost remarkable by the medical profession. It has been tried at the Cleveland Hospital, Johns Hopkins in Baltimore, and the Presbyterian Hospital here, and is still in use at all three institutions. It was first tried at the Presbyterian Hospital early in the year.

“Excellent results have been obtained at this hospital with the new treatment,” said Dr. J. Eliot Overlander, the Assistant Superintendent of the hospital. “All of the patients treated by the method have improved rapidly.”

It was learned that between fifteen and twenty patients had been treated by the new method at the hospital, and that all but one had been discharged. On leaving the hospital they said that they felt better than they had at any time before since contracting the disease. They were instructed to continue on a somewhat reduced diet after being discharged, but were allowed to eat a small amount of foods containing starch.

October 11, 1915

Serum Proves Boon in Fighting Diabetes

Experiments in the treatment of diabetes, hitherto regarded as practically incurable, have met with remarkable success, according to reports officials of the Carnegie Corporation, which has made an appropriation toy research work at the Potter Metabolic Laboratory and Clinic in California. The treatment that is being administered has given relief in practically all the cases under observation.

The ravages of the disease have been checked by application of a serum discovered by Canadian physicians working under Dr. J. J. R. Macleod of the University of Toronto. This serum has been used at the Potter laboratory. Thus far relief has been dependent upon constant application of the serum. It is too early, physicians say, to describe the treatment as a “sure cure” for diabetes, for the experiments at the Potter laboratory have been going on for only about eighteen months.

Dr. Henry S. Pritchett, President of the Carnegie Corporation, who recently visited the Potter clinic and observed the experiments there, has made a report on the study and treatment there of diabetes, for incorporation in the annual report of the corporation.

Dr. Potter First Started Work

Dr. Potter’s metabolic research began at the French Hospital here. He removed to Santa Barbara, Cal., where a metabolic clinic and laboratory was built by public-spirited Californians. The Carnegie Corporation has aided the work by an annual appropriation. Dr. Potter died in 1919, and since then the work has been carried on under the direction of W. D. Sansum.

Intensive studies on the internal secretion of the pancreas had been carried on in the meantime under Dr. Macleod in Canada. It has long been known that some pathology of the pancreas is responsible for diabetes. Dr. F. G. Banting, working under Dr. Macleod, carried on intensive experiments to extract a substance from pancreatic tissues. This substance was first injected into dogs suffering with diabetes. The diabetic symptoms disappeared with the application of the serum, which is known as insulin. Convincing results of the efficacy of the serum were obtained by Dr. Banting in the cases of humans suffering with the disease.

“On account of the admirable facilities in the Potter Metabolic Clinic in Santa Barbara and the opportunity afforded by the close association of laboratory and hospital,” Dr. Pritchett’s report says, “Dr. Macleod and his associates most generously and kindly communicated to Dr. Sansum and his staff in Santa Barbara such full information as they had and because of the urgent need for such an extract of the pancreas urged their immediate co-operation. With the information thus generously given through Dr. Macleod, the staff of the Potter Metabolic Clinic began strenuous efforts in the insolation of the internal secretion of the pancreas now known as insulin. They were immediately successful and within two months had been able to secure a sufficient amount of insulin to use on nine severe cases of diabetes.

Success of Treatment Established

The results have been so convincing that there can be no doubt of the great value of this substance in the treatment of diabetes and it is quite within the possibilities that the discovery may result in the relief and cure of great numbers of people from this scourge. The following cases will illustrate the extraordinary sort of results which have been obtained:

“A patient of 53 years of age was sent to the clinic on the verge of diabetic coma, apparently death within a few days awaited him. Following the administration of insulin he became immediately free from sugar, his diet could be increased to normal and he is rapidly gaining in strength and weight.

“A boy of 12 in extreme illness through diabetes became free from sugar after twenty-four hours of treatment with insulin [and] has remained free although his diet has been increased to practically normal. This boy is gaining weight at the rate of half a pound a day and is leading the type of life that any normal active child would lead. By the older dietary methods partial starvation would have been necessary even to prolong life, to say nothing of restoration to health. The results in the other cases have been equally astonishing.”

Expense of Serum Is Very Great

“The problem is of course still in its infancy. Insulin is prepared at present at very great expense. Cheaper methods of production must be devised. A study of the intricate chemistry of the product will undoubtedly add materially to our knowledge of the oxidative processes going on in the body about which practically nothing is known at present. But the great gains seem to be that patients with the use of this new agent will not only be able to be sugar free, but will be able to have normal diets with the strength and health which can come alone from the use of such food.

“The brilliant success which has come from this study and the still more brilliant prospects of the future which it holds out form a source of the greatest encouragement to the trustees of the corporation that their gifts may, if given with discretion, advance the cause of medical knowledge and thereby increase human happiness and usefulness in the most desirable fashion. Mr. Carnegie had always in mind the desire to ‘find the efficient man and enable him to do his work.’ Not every research can show the brilliant results which have come out of these investigations, but all patient, long-continued study adds, little by little, to the sum of knowledge, enriches life, and helps to turn away misfortune.

“Not the least pleasing feature of this investigation lies in the generous and admirable attitude in which two sets of investigators, each of whom has revived modest help from the Carnegie Corporation, have co-operated toward their common end. It was a graceful and generous act on the part of Dr. Macleod and his colleagues to put at the service of the Potter Metabolic Clinic the full results of their important researches, but this action is in entire consonance with the spirit and the purpose of true scientific research.”

October 8, 1922

Virus Link Is Found in Diabetes Patient

By HAROLD M. SCHMECK JR.

In the first thoroughly documented instance of its kind, a virus has been linked to a fatal case of diabetes under circumstances that make it almost certain that the virus caused the disease.

A report of the case has been published in the current issue of the New England Journal of Medicine, together with an editorial that described the new evidence as “highly important.”

The case and research related to it provide strong evidence that virus infection is among the causes of the most serious form of diabetes, known as juvenile-onset diabetes. How common this kind of link may be is unknown. Juvenile-onset diabetes is distinct in many respects from the more common adult-onset diabetes and tends to be more severe.

A Government announcement described the case as the first in which a virus had been recovered from the pancreas of a juvenile diabetes patient.

Classic Requirements for Proof

For almost a century scientists have tried, but always failed, to prove that some juvenile diabetes is caused by virus infection. The new research seems to fulfill all the classic requirements for proof. The new evidence also indicates that heredity is a factor in susceptibility to virus-caused damage to the pancreas.

The editorial said the new findings offered “challenges for future research” and “cause for optimism” concerning the understanding and treatment of this serious illness. The editorial suggested the possibility of a vaccine for some persons who might be at high risk of developing diabetes and use of anti-inflammatory or immunosuppressive treatment for some diabetics to minimize damage to the pancreas, the gland where insulin is produced.

The possibility of such a vaccine, however, is conjectural and perhaps far in the future. The concept is complicated by the fact that the virus involved in this case and other viruses suspected of possible links to some juvenile diabetes cases are widespread in the human population while the disease is much less common.

The new report was by scientists of the National Institute of Dental Research and the National Naval Medical Center in Bethesda, Md. They described the case of a 10-year-old boy who had no previous evidence of diabetes but developed a serious form of that disease two days after what appeared to be a mild flu-like illness.

The boy was hospitalized because of severe lethargy and abdominal cramps. He also showed some of the common symptoms of diabetes, including excessive thirst and urination. Doctors soon found that he had the biochemical derangements typical of serious diabetes. Even though he was given insulin and other treatment, he died about a week after the illness began.

Recovered the Virus

Scientists recovered a virus called Coxsackie B4 from the boy’s pancreas. They grew this in tissue culture and then injected it into mice, some of which developed the same serious form of diabetes with destruction of the insulin-producing cells of the pancreas.

Thus, the team of scientists fulfilled all of the classic conditions required for proof that a given virus or bacterium is the cause of a specific illness.

They took elaborate care to rule out the possibility that the virus was a laboratory contaminant. The fact that some strains of laboratory mice developed diabetes while others did not suggests that heredity influences the risk that virus infection will cause the disease. Persons of certain identifiable tissue types are known to be more likely than others to develop diabetes. Furthermore the boy had relatives who were diabetics.

An announcement yesterday from the dental research institute said the case was the first documented instance of recovery of a virus from the pancreas of a patient with juvenile diabetes. The institute is a unit of the National Institutes of Health.

The combined evidence of the research and the highly unusual case in a young boy has suggested to the scientists that hereditary susceptibility, virus infection and a situation in which the body assaults its own tissues may be responsible for some cases of juvenile diabetes.

Circumstantial Evidence

Although they have no indication of how common virus-linked diabetes may be, the scientists note in their report that there has been much circumstantial evidence over the years linking it to various virus infections. This is not believed to be true of adult-onset diabetes, a more common condition that some scientists believe to be essentially a different disease from the serious so-called juvenile form.

Authors of the report in the medical journal were Drs. Ji-Won Yoon, Marshall Austin, Takashi Onodera and Abner Louis Notkins. Dr. Austin is a pathologist and virus specialist of the Naval Medical Center, where the boy’s pancreas was studied. The others are scientists of the dental research institute who have long been interested in possible virus links to diabetes.

In earlier research, the team led by Dr. Notkins produced the equivalent of diabetes in mice by infecting them with certain strains of Coxsackie virus and another variety called Reo virus type 3. Strains of both viruses are far more widespread in the human population than is juvenile diabetes.

Coxsackie virus, named for a community in upstate New York where it was discovered several decades ago, is known to produce flu-like infections. It has also been suspected of contributing to some cases of diabetes, because of the laboratory research on mice.

In an interview, Dr. Notkins said it was clear that diabetes was not a common result of infection with Coxsackie virus because at least 50 percent of Americans have been infected with it at some time, while less than one-tenth of 1 percent of Americans ever develop juvenile diabetes. The scientist said the virus-diabetes situation might be somewhat analogous to that of polio virus infections, only a few of which actually produce paralysis.

May 24, 1979