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two men whom he really loved, Herbert Allingham Iand John Nachbar, were taken from him ; the onetlramatically, the other slowly and inevitably. His idomestic life was a long-drawn-out pattern of unflinch-ingly courageous misery. He was greatly gifted. He Ihad one of the acutest constructive brains that I have

ever come in contact with, and his destructivecriticism was as sound as it was usually merciless.The real distinction of his fine character and greatattainments was written on his Napoleonic features ;and so, latterly, was his acute and constant physicaland mental suffering. The customary gravity of hisface would occasionally be relieved by a smile ofalmost feminine sweetness and beauty, for he lovedthe lovable in life and had a keen and subtle sense ofhumour. He has succumbed to a long, painful, andexhausting illness. and, fond as I was of him, andmuch as I shall miss him, I cannot regret his release.He was a lonely man, who had outlived his ambitionsand lost his illusions : may he rest in peace."

I

THE LATE DR. ALFRED GEORGE SIMMINS :AN APPEAL.

OUR readers may have noticed in THE LANCET ofMarch 31st the coincidence of the death on March 23rdof Temp.-Surg. Lieut. Alfred George Simmins, R.N.,and his wife. The double event was due to influenza,and the husband was only 32 years of age, the wifebeing just his senior. Dr. Simmins was educated atGuy’s and Westminster Hospitals, qualified in 1914,and on the outbreak of war gave up a post in theMetropolitan Asylums Board to serve in the Navy.During his period of service he took the degrees ofM.B., B.S. Lond. Demobilised in 1919 he acted fora time as medical registrar at Westminster Hospitalbefore succeeding Dr. Croly in general practice at

Hornsey. His excellent record was a guarantee ofprofessional success, to which death has put so tragica term.We have received the following moving appeal on

behalf of the children left orphaned in this patheticmanner :

" They leave three little children, for onlyone of whom-a boy of 6-some provision has beenmade. No funds are available for the education ofthe other two, a girl and boy, aged 4 years and 15months respectively, and they are left pennilessorphans. At the time of the catastrophe Simminswas making good, but there was an overdraft at hisbank as a result of the purchase of his practice, andhe was precluded from the ordinary terms of lifeinsurance by albuminuria, the relic of a previousattack of influenza. Even in these case-hardeneddays it would be difficult to find a parallel to such acombination of misfortunes, and we are proud tobelieve that our appeal will evoke a generous responsefrom all branches of the profession. A committee isin process of formation, and several generous donationshave already been received."The appeal is signed by Sir William Hale-White,

Sir James Purves-Stewart, Dr. G. F. Still, Dr.Henry C. Semon, and Dr. David Nabarro. Cheques- and postal orders should be sent to the Treasurer,Simmins Appeal Fund, and addressed Royal NorthernHospital, Holloway-road, N. 7.

INSULIN AND THE TREATMENT OFDIABETES.

ON Nov. 17th, 1922, and Feb. 21st, 1923,1 theMedical Research Council published statementsexplaining the measures which have been taken in thiscountry for studying the production and the propertiesof insulin, and for promoting its manufacture hereupon a commercial scale. The following additionalstatement can now be made:-

Large-Scale Production.British-made insulin is now being supplied from two

sources-namely, the firm of the British Drug Houses,Ltd., in conjunction for this purpose with Messrs.Allen and Hanburys, and that of Messrs. BurroughsWellcome and Co. These firms, who undertook themanufacture under agreement with the MedicalResearch Council, have satisfied all the requirementsand tests of the Council for authenticity, standardvalue, therapeutic efficiency, and sterility of theproduct sold. It is hoped that these sources of supplywill be augmented at an early date by three otherfirms in different parts of Great Britain who are undersimilar agreements with the Council. It should beunderstood that the rapid progress made by thesefive firms since the end of last November, and theactual achievement of successful and guaranteedsupply within a period of little more than four monthsfrom the first attempts at large-scale production, havebeen made in spite of some serious handicaps. Thelarge quantities of alcohol used for extraction broughtthe manufacture under almost prohibitive restrictionsuntil certain concessions were made by the Commis-sioners of Customs and Excise, which allowed speciallydenatured alcohol to be used duty-free. The embargoupon importation of Canadian cattle had greatlyreduced the supply of fresh raw pancreas materialin this country and a good deal of improvisation andinitiative have been necessary for the effectiveorganisation of the available supply of raw materialduring recent months. The only limit now placed,and likely to be placed for some time, upon Britishproduction is the limitation of raw material availableunder suitable conditions.

In the meantime, Messrs. Eli Lilly and Co., ofIndianapolis, Indiana, working under agreement withthe University of Toronto, have been proceedingtowards large-scale production since the early summerof 1922. By the courtesy of the University, this firmwas able to submit samples of their insulin productto the Medical Research Council in February last fortesting. At the end of March, Messrs. Eli Lilly foundthemselves in a position to offer the Medical ResearchCouncil a considerable supply of their product fordistribution in this country under similar restrictionsto those at present governing distribution during aprovisional period in the United States and Canada—namely, to approved hospitals and to physicians withapproved clinical facilities. In view of the urgencyof the demand, the Council cabled for this supple-mentary American supply, of which the first consign-ment is expected to arrive during the present week.It is a remarkable coincidence that the products oflarge-scale American production should become avail-able here only a few days after the first commercialsupply of British insulin.

American and British Sources.The Medical Research Council have arranged that

the insulin of American manufacture should be distri-buted by those British firms whose own product isalready available or may hereafter become available,and the amount distributed by each British firm will be

in proportion to the volume of its own production.Both British and American insulin will be sold hereonly under that name (except for the addition of marksor brands indicating origin). A maximum sellingprice has been fixed by agreement with the Councilfor a short provisional period, and there is a

1 THE LANCET, Nov, 18th, 1922, Feb. 24th, 1923.

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probability of its being reduced at an early date. TheBritish firms have adopted a method of purificationof the final product worked out by Dr. Dudley at theNational Institute for Medical Research. By thismethod it is possible to get rid of over 90 per cent. of the solid matter in the crude end-product of the I

original process, and it allows the manufacturers tooffer the active principle in the form of hydrochloridein highly concentrated form, freed from accidentalirritants and other substances. For the avoidance ofimproper exploitation of this valuable process, pro-visional application has been filed by Dr. H. W. Dudley,jointly with the Medical Research Council, for patentrights. It is probable that in the near future theAmerican supplies will be submitted to the same

process and offered in the same form.All the supplies now available have passed suitable

laboratory and clinical tests for purity. potency, andsterility. The physiological unitage originally indicatedby the first producers of insulin in the University ofToronto has not been retained. By agreement withthe University, the American manufacturing firm has made current in the United States a unit having theapproximate value of one-third of the original Torontounit. The Medical Research Council have decided toadopt this smaller unit, so that al the insulin now madeavailable in this country, whether British or American,will be standardised to a common unit value. Everybatch put upon sale, of whatever origin, will bebiologically tested under the supervision of the Council,and every preparation sold must bear a number

corresponding with that of the batch from which ithas been drawn.

Distribution 0/ arte Avaitable Supply.For a provisional period the Council have retained,

under their agreements with the manufacturers,control over the distribution of the commercialsupplies analogous to that exercised by the Universityof Toronto over the products of American manu-facture. It is clearly desirable, apart from otherconsiderations, that now, and at least until the supplyis more than equal to the demand, the availableinsulin shall be distributed so as to reach those patientswhose need is greatest, and so as to be placed in thehands by which it can be administered to the greatesteffect and with the least waste. Difficult problemsarise here of interest and importance to the public, tothe medical profession, and to hospital administrations.The research work, both in the laboratory and in

the wards, which has brought manufacture in this’country to its present pitch, and all the connectedproblems of standardisation and further research work,fall properly within the sphere of the Medical ResearchCouncil. These medical administrative problems of Idistribution, on the other hand, have been submittedby the Council to the Minister of Health within whoseresponsibility they properly lie. Having regard to thespecial nature and urgency of the occasion, theMinister has appointed a small Committee to advisehim upon the subject, composed as follows : Sir

George Newman (chairman), Dr. R. A. Bolam, SirWalter Fletcher. Sir Humphry Rolleston, Dr. Alfred’Salter, M.P., Dr. G. F. McCleary (secretary) (address,Ministry of Health, Whitehall).To avoid any unnecessary delay, provisional

authority had been given to the firms to distributeinsulin to various large hospitals, and the firstBritish-made insulin was actually so supplied onApril 12th. On the advice of this Committee,manufacturers will be directed, during the presentperiod of restricted production, to supply insulinonly to those hospitals and to those registeredmedical practitioners who have proper facilities attheir connnand for making accurate blood-sugardeterminations.

Restrictions Imposed.Each hospital and practitioner so supplied will

undertake to observe the following restrictions uponthe use of insulin :-

1. Careful correlation will be made of the diet, of the blood- sugar changes, and of the insulin dosage in each case. For I

at least one group of cases it is known already that theinsulin dosage can be reduced progressively with suitableadjustment of diet. This reduction allows economy ofinsulin, besides the advantage it may bring to the patient.

2. Insulin will not be given to those whose symptomscan be controlled by moderate restrictions of diet. Thereshould be no luxury use of insulin till supplies are abundant.

3. It is understood, of course, that in emergency and apartfrom the careful correlation just mentioned, insulin will begiven to those in diabetic coma or those nearly approachingit, and it may be given to those with diabetic symptomsneeding special preparation for some surgical operation.

4. Care will be taken to avoid the danger of giving insulinto non-diabetic cases (e.g., to patients with renal glycosuria).Hospitals or practitioners desiring supplies forimmediate use should apply to one or other of theBritish firms named above.

It is hoped that at a very early date preliminarycommunication will be made of the results of theinsulin treatment which has been in progress duringthe past months in the hospitals at London, Edinburgh,Glasgow, and Sheffield, named in the earlier statementby the Council, in order that experience gained in thisclinical research work may be put at the disposal ofthe profession for their information and guidance.

Medical News.CONJOIN T EXAMINATIONS IN IRELAND BY THE

ROYAL COLLEGE OF PHYSICIANS AND THE ROYAL COLLEGEOF SURGEONS.—The following candidates passed the springexaminations :-

Third Professional Examination.—Anna Allen, P. M. Banim,Moira E. Connolly, Bridget Crawford, T. A. Cronhelm,J. Dalrymple, Pauline M. Dooley, R. G. Freeman, V. D.Gordon, J. A. Hynes, Wilhelmina C. Maguire, M. A. Monahan,A. ffrench O’Carroll, W. O’Connor, and P. C. Raftery.

Final Professional Examination.—Thomas Aitken Austin,Alan Plewman Brown, Josephine Alcorn Carson, MauriceCremin, Victoria Elizabeth Davidson, Evelyn SylviaDelany, John Francis Devlin, Douglas Arthur T. Eaton,Isaac Jabob Eppel, Thomas Valentine Fitzpatrick, SydneyGeorge Gilmore, Alphonsus Joseph Harte, Michael JosephO’Riordan, Robert Dobbs Seale, and Vincent Francis Walsh.

ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH,ROYAL COLLEGE OF SURGEONS OF EDINBURGH, AND ROYALFACULTY OF PHYSICIANS AND SURGEONS OF GLASGOW.—Atexaminations recently held the following were successful :—

THIRD EXAMINATION.Alastair F. B. Mackay, Eleanor P. Topping, William A. Kemp,

Charles Campbell, John S. Caldwell, Radcliffe D. Jones,Joseph F. Sweeney, Carapiet Aviet Basil, David D. Radford,Alexander J. M. Findlater, Harold V. R. McKinlay,Constance P. H. Hunter, James D. Edminson, FrederickBlacklee, William Rogers, John C. Shiach, Mollie F. Churcher,Cecil J. R. Morrison, Adam S. Gordon, Albert E. Williamson,Moss M. Bronstein, Cavin J. Bell, Donald L. Crawford,Petrus Johannes Badenhorst, James K. Hunter, GeorgeR. Mitchell, and Alexander S. Ballantine.

Pathology.—Leslie V. Sherrin.Materia Medica.-John B. Hutchison, John Lees, WilliamMcKim, William A. Evans, Margaret M. McCusker, JosephHorsham, Joseph B. Stromier, Winifred G. Price, DavidD. H. Craig, John M. Coutts, Sarah Boyle, Robert H.McKinnon, John J. MacKenzie, Irma E. L. Mackenzie,David Lumsden, Lewis Mackenzie, Douglas B. Craig,John J. Olcgenna, and Charles E. Millen.

FINAL. EXAMINATION.The following candidates having passed the Final Examination,

were admitted L.R.C.P.E., L.R.C.S.E., L.R.F.P. & S.G. :—James M. McLintock, Minnie E. McMurray, John 1B1.

Cockburn, Behari Lal Chopra, Nicholas J. Laubscher,William N. Stirling, George Abeysinche W’eera Wickrama-suriya, Daniel Maximos, Dinbai Jehangeer Dubash, EdwardR. C. Walker, Philip G. Bainbridge, William Paris, JonathanJohan du Pre le Roux, James H. Murrell, Sarel Jacob Reich,Daivasikamany Kanaka Sabhesan, Ernest Levine, LouisJafflt, John J. Mann, Don Valentine Walpola, and James S.Bizzett.

Medicine.—Hari Prasanna Sen, Wilhelmina C. Storrie, RubyS. Beveridge, Eliazar Gelfer, Donald G. Coutts, Martha D.Devon, Maurice N. Gelb, George A. P. McConey, and DuncanR. Nicol.

Surgery.—Cyril A. Paulusz and OIauriee Gelb.Midwifery.—Thomas F. Kelly, Ruby S. Beveridge, Cyril A.

Paulusz, William E. Haydon, Martha D. Devon, George A. P.-AleConey, and Thomas J. Muir.

Mledical Jurislirzicience.-Johii --BIeCann, John S. Whiteside,Joseph McAuley, Anna G. Laubscher, Darwish MoustafaSafwat, Eliazar Gelfer, Harold V. R. McKinlay, Arthur W. H.Noble, James Ryan, Lauchlan McLean. and Mart- C. Semple