Diabetes: Past, Present and Future

I MAKE no apology for speaking to you tonight in my presidential address on diabetes. During more than thirty years I have done much work at this disease, having seen more than ten thousand cases of it in all, and having been concerned in its investigation and treatment both in the pre-insulin and insulin eras. At the beginning of my medical life very little in the way of practical useful treatment was available to sufferers from the disease, and I doubt whether half a dozen blood sugar estimations had been carried out in the North of Ireland. The life of the diabetic was then indeed a miserable existence, in which he went on in a state of semi-starvation and invalidism, trying to postpone for as long as possible the evil day when he would die in coma, or of some intercurrent infection. Today, with proper care and a not unduly exacting co-operation, he can be perfectly fit and well, and carry on successfully with almost any work he cares to undertake. I often hear the remark, "Your diabetics look so fit and well." Last year, in the Royal Victoria Hospital alone, twenty thousand blood sugar determinations were carried out. I would briefly like to review the medical history-not the history of diabetes itself, for that is probably longer than that of the human species. It is now known to occur in some of the lower animals. The disease was mentioned in the Ebers papyrus, which dates from approximately 1500 B.C., almost one thousand years before the birth of Hippocrates. It was recognised as a clinical condition in very early Indian writings and was then probably, as now, prevalent among Hindus. The early Greek physicians seem to have been ignorant of it, but it was mentioned by those of a later date. Knowledge of the pancreas was set forth by Galen in the second century A.D., but he, of course, did not appreciate its connection with diabetes, of which condition he only recognised two cases. About the same period the disease was named "diabetes" 73