This quick description of the Allen method rnight go unrernarked by readers unfamiliar with serious diabetes and in an age when most of us have to diet occasionally. At the time he introduced what came to be called the "starvation treatment" of diabetes, Allen was advocating serious dieting in a country where being well-fed was still a sign of good health. More ironically, he was advocating serious dieting to patients two of whose complaints were their terrific hunger and their rapid weight loss. They came to the doctor to be treated for these symptoms and the doctor seemed to be telling them that they had to be hungry more often, that they had to lose even more weight. The ironies, the Hobson 's choices, the catch-22's of the treatment were staggering. An adult diabetic, weak, emaciated, wasted to perhaps ninety pounds, would be brought into hospital and ordered to fast. If the patient or the patient's family complained that he or she was too weak to fast, Dr. Allen replied that fasting would help the patient build up strength. If the patient complained about being hungry, Allen said that the fasting would help ease the hunger. Suppose the method didn't seem to work and the symptoms seerned to get worse. The answer, Allen insisted, was more rigorous under-nourishment: longer fasting, a maintenance diet even
symptoms seemed to get worse. The answer, Allen insisted, was more rigorous under-nourishment: longer fasting, a maintenance diet even lower in calories. To top it off, Allen and others were also urging diabetics to take as much physical exercise as possible, claiming it would help them burn more food and increase in strength. Where was the limit to the dieting? Where would you stop? In fact there was no limit. In the most severe cases the choice came to this: death by diabetes or death by what was often called "inanition." "The plain meaning of this term," Allen wrote, "is that the diabetes was so severe that death resulted... from starvation due to inability to acquire tolerance for any living diet." ' 'The best safeguard against inanition," he added, "consists in sufficiently thorough undernutrition at the outset." In those situations where the awful choice between death from diabetes and death from starvation could not be avoided, "comparative observations of patients dying under extreme inanition and those dying with active dia- betic symptoms produced by lax diets or by violations of diet have con- vinced us that suffering is distinctly less under the former program. "24 To ill ustrate, consider Rockefeller case 60, a forty-three-year-old house- wife who came into the hospital on New Year's Day, 1916, having lost 60 pounds in the few months since the onset of her diabetes. She weighed 36 kilograms or 79 pounds on admission, and was so weak that even Allen hesitated to go ahead with severe fasting: The experiment was tried of feeding more liberally for a short time in the attempt to restore some strength, so as to get a fresh start for further fasting.... the attempt caused only harm instead of benefit, as always in genuinely severe cases. The question thereafter was whether the glycosuria could be controlled without starving the patient to death. ...Though the food was thus pushed to the utmost limit of tolerance, it was not possible to prevent gradual loss of weight. She was utterly faithful in fol lowing her diet, which during hospital stays averaged 750 calories a day and about I ,000 calories when she was at home. When A1 len last saw her, in April 1917 , her weight was down to 60 pounds and falling. "Perhaps better results might have been obtained by cutting down the weight to perhaps 30 K (66 pounds) at the outset," he mused in the conclusion to the discussion of her case. "The question remains whether the pancreatic function is absolutely too low to sustain life, or whether by sufficiently rigid measures downward progress can be halted even at this time." The answer was given in a footnote added in the final revision of the manuscript: ' 'Largely on account of her residence in a city too far away to permit personal supervision and encouragement, this patient finally broke diet, and after a rapid course of glycosuria and acidosis, died in Feb. 1918."25
Many of Allen's patients broke diet out of hospital, some sooner than others. Case I embraced Christian Science four months after her release, began eating everything at will, and died in a few more months. Case 51 , a seven-year-old Polish-American schoolboy, was able to sneak food at home unknown to his parents, and died from it; "the essential cause of trouble lay in the horne conditions of an uneducated Polish laboring family." Case 18 was a sixteen-year-old errand boy who adhered to his diet fairly well until summertime when he had a feast of cherries. After that he became uncontrollable and went downhill.26
continued, ' 'because of the strong theoretical inducements," Allen noted. The most interesting and important of these new attempts involved experiments measuring the effect of pancreatic extracts on blood sugar. High blood sugar, or hyperglycemia, had been recognized for many years as a sine qua non of the diabetic condition. Measurements of blood sugar had not usually been involved in diabetes therapy or research, however, because they were very difficult. The chemical tests required to estimate the amount of sugar in the blood called for a lot of blood, usually twenty cc. or more. It was difficult and possibly dangerous to take many of such large blood samples from either humans or animals. As well, methods for testing the sample were time-consuming and so crude that the margins of error in estimating the percentage of blood sugar were very high. It was much more practical, safer, and perhaps more accurate to test the diabetic condi- tion through urine samples alone. But accurate blood sugar readings would obviously be a useful research tool, supplying a far more reliable guide to diabetes than urine tests. All of
symptoms seemed to get worse. The answer, Allen insisted, was more rigorous under-nourishment: longer fasting, a maintenance diet even lower in calories. To top it off, Allen and others were also urging diabetics to take as much physical exercise as possible, claiming it would help them burn more food and increase in strength. Where was the limit to the dieting? Where would you stop? In fact there was no limit. In the most severe cases the choice came to this: death by diabetes or death by what was often called "inanition." "The plain meaning of this term," Allen wrote, "is that the diabetes was so severe that death resulted... from starvation due to inability to acquire tolerance for any living diet." ' 'The best safeguard against inanition," he added, "consists in sufficiently thorough undernutrition at the outset." In those situations where the awful choice between death from diabetes and death from starvation could not be avoided, "comparative observations of patients dying under extreme inanition and those dying with active dia- betic symptoms produced by lax diets or by violations of diet have con- vinced us that suffering is distinctly less under the former program. "24 To ill ustrate, consider Rockefeller case 60, a forty-three-year-old house- wife who came into the hospital on New Year's Day, 1916, having lost 60 pounds in the few months since the onset of her diabetes. She weighed 36 kilograms or 79 pounds on admission, and was so weak that even Allen hesitated to go ahead with severe fasting: The experiment was tried of feeding more liberally for a short time in the attempt to restore some strength, so as to get a fresh start for further fasting.... the attempt caused only harm instead of benefit, as always in genuinely severe cases. The question thereafter was whether the glycosuria could be controlled without starving the patient to death. ...Though the food was thus pushed to the utmost limit of tolerance, it was not possible to prevent gradual loss of weight. She was utterly faithful in fol lowing her diet, which during hospital stays averaged 750 calories a day and about I ,000 calories when she was at home. When A1 len last saw her, in April 1917 , her weight was down to 60 pounds and falling. "Perhaps better results might have been obtained by cutting down the weight to perhaps 30 K (66 pounds) at the outset," he mused in the conclusion to the discussion of her case. "The question remains whether the pancreatic function is absolutely too low to sustain life, or whether by sufficiently rigid measures downward progress can be halted even at this time." The answer was given in a footnote added in the final revision of the manuscript: ' 'Largely on account of her residence in a city too far away to permit personal supervision and encouragement, this patient finally broke diet, and after a rapid course of glycosuria and acidosis, died in Feb. 1918."25
Many of Allen's patients broke diet out of hospital, some sooner than others. Case I embraced Christian Science four months after her release, began eating everything at will, and died in a few more months. Case 51 , a seven-year-old Polish-American schoolboy, was able to sneak food at home unknown to his parents, and died from it; "the essential cause of trouble lay in the horne conditions of an uneducated Polish laboring family." Case 18 was a sixteen-year-old errand boy who adhered to his diet fairly well until summertime when he had a feast of cherries. After that he became uncontrollable and went downhill.26
continued, ' 'because of the strong theoretical inducements," Allen noted. The most interesting and important of these new attempts involved experiments measuring the effect of pancreatic extracts on blood sugar. High blood sugar, or hyperglycemia, had been recognized for many years as a sine qua non of the diabetic condition. Measurements of blood sugar had not usually been involved in diabetes therapy or research, however, because they were very difficult. The chemical tests required to estimate the amount of sugar in the blood called for a lot of blood, usually twenty cc. or more. It was difficult and possibly dangerous to take many of such large blood samples from either humans or animals. As well, methods for testing the sample were time-consuming and so crude that the margins of error in estimating the percentage of blood sugar were very high. It was much more practical, safer, and perhaps more accurate to test the diabetic condi- tion through urine samples alone. But accurate blood sugar readings would obviously be a useful research tool, supplying a far more reliable guide to diabetes than urine tests. All of
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