Dietetics being opened in the Royal Infirmary underthe direction ofMiss Pybus and sponsored by ProfessorDavid Murray Lyon. This was again a first for Edin-burgh, though it should be mentioned that a course ofdiatetics had been provided from 1927 at the Glasgowand West of Scotland College of Domestic Science."'During the past 50 years treatment for diabetes has

developed and methods have been modified. TheEdinburgh School has made its useful contribution tothis progress, and it seems worth while to salute thosepioneers who supplied the initial impetus when insulinwas discovered.

I thank Professor Michael Bliss, Toronto, for help andencouragement and the following archive departments for.-making copies of their records available: the University ofToronto for the MacLeod papers; MRC for correspondencewith J C Meakins; Edinburgh University Library for access to

the general register of patients. The manuscript of Professor JC Meakins's memoirs is held in the Osler Library, McGillUniversity, Montreal. Miss J P S Ferguson, librarian to theRoyal College of Physicians, Edinburgh, also gave valuableassistance.

1 Lyon DM, Meakins JC. The treatment ofdiabetes mellitus. EdinburghMedicalJournal 1921;27:270-85.

2 Lyon DM. Xanthoma diabeticorum. Edinburgh Medical journal 1922;28:168-74.

3 Bliss M. The discoveryof insulin. Edinburgh: Paul Harris, 1983.4 Haines T. Discovery of insulin came in the nick of time for surgeon. Hospital

Medicine 1983;33: 10-1.5 Davies HW, Lambie CG, Lyon DM. The influence of insulin on acidosis in

diabetes. BMJ7 1923;i:847-9.6 Lyon DM. The use of insulin. Lancet 1924;ii:158-62.7 Lynn DM. Standard diets for use in diabetes. BMJ 1924;ii:326-9.8 Dunlop DM. Dietetic treatment of the average diabetic. Edinburgh Medical

Journal 1938;45:415-34.9 Buchan A. Growth of the dietetic department. Nutrition 1954;8:72-7.10 Hutchinson E. History of the British Dietetic Association. London: Newman,

1%1.

The medical muse

Fritz Spiegl

It has long been held-probably since Pythagoras-that an aptitude for music goes hand in hand witha mathematical mind. Indeed there are many dis-tinguished mathematicians who excel in music, but myown observations suggest that musical accomplishmentis more widespread among doctors than in any otherthinking profession. Perhaps Bacon had the right idea.The ancients did well to conjoin music and medicine, becausethe office of medicine is but to tune the curious harp of man'sbody.

That was long before anyone demonstrated anyscientific basis for music therapy.

If you require evidence look around you and listen.The country-no, the world-seems to be full ofmusical doctors. Many people of my generation wholistened spellbound to Boyd Neel and the pioneeringEnglish chamber orchestra that bore his name wereunaware that he was in fact a music loving doctor.His musical descendant, Jeffrey Tate of the EnglishChamber Orchestra, also started life as a medical man.

Three medical bassoonistsWhen I was a music student one of my own earliest

appearances as a soloist was under the baton of Dr Dolf

VYW$.... F ~~~~~~~a.'4

"Mrs Winslow's Soothing Syrup"

Polak of King's College Hospital. On that occasion inthe 1950s he also guided Alfred Deller through a Bachcantata. I used to play in an amateur orchestra whosebassoon section was manned by three medical scientists-each one a fellow of the Royal Society-led by theCambridge pathologist William Rushton.

University orchestras, although diminishing underthe onslaught of discoth~ques and the general stulti-fication of the Walkman battered, cloth eared young,still somehow manage to absorb their usual highproportion of musical doctors. Time and again it hasbeen noticed that children who are subjected to theearly discipline of mastering a musical instrument areacademically brighter and develop a greater capacityfor learning, not least eye and muscle coordination.

I sometimes wonder how all these multitalenteddoctors find the time. The flautist and conductor (andone time musical arranger for the King's Singers)

I ~~~~~~~~~~~~~~~~~~~~~~1

4 Windermere Terrace,Liverpool L8 3SBFritz Spiegl, ARAM, musician,writer, and broadcaster

BrMedJ7 1990;301:1454-6

Eighteenth century doctorsmake music-on close stooldrums, glyster pipe bassoon, andsyringe flageolet

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"The Pain-Killer Polka"

physician to tphysician" to tcomposed somEnglish glee ccintended for ahis first operatgave up all th(lessons with HCatch Club. Nback to mediNorman O'Nttragically youiparatively muninadequate firs

Another mewas Dr Franc(MD, GlasgovCollege of Phcareers: physiTrinity Colleg4Catch Club, N

signed some cFrancis Irelan(Mother: Oh Do(Poor Nancy myBut you come, IDoctor: The firsIs breathing a VoIf you'll let me b

In other woRobert Sells happens also to be the past president of the the glyster.British Transplantation Society: the evening before Even thehghosting this year's Liverpool meeting of the society he produce a marwas conducting Tchaikovsky's Patheitique in the popular treatrPhilharmonic Hall. When the Royal Liverpool using liquoricPhilharmonic has found itself short of a bassoonist the gone throughservices are available of the pathologist Dr Robert name ofthepaConnolly, whose other distinctions include important in the annals (work on the prehistoric Marsh Man. Occasionally he is Baron von MiUjoined there by his horn playing brother, David, a confidence tridistinguished spectroscopist. That mostAn American consultant, Dr Gilbert Kaplan, has figures in mu

conducted Mahler's Third Symphony with some of thegreat orchestras. Admittedly he hired them, but healways acquitted himself with credit. (And if anyprofessional conductors are tempted to question hiseffort let them change places with him one day in thedoctor's office.)The list is almost endless and even transcends the

ancient East and West divide in music. The consultantanaesthetist Dr Aly Sadek, with Dr Wafaa El-Sissi, lastyear took time off to produce the first recording inArabic, and with an all Egyptian cast, of Mozart'sCosi fan tutte. (They are translating all Mozart's operasinto this very melodious and singable language-though I specially look forward to Die Entfihrung to seehow the doctors handle the scene where Belmontemakes alcoholic jokes about the prophet and gets themoslem servant Osmin drunk.)When you next listen to Alexander Borodin's Prince

Igor remember that he wrote it as a relaxation from hisday job as reader at the St Petersburg Medical-SurgicalAcademy, where he worked on a 10 year researchprogramme into "the condensation of the aldehydes ofvalerian, enantol and vinegar." Music is an uncertainprofession and the Swedish composer Franz Berwald(1796-1868) was not alone in embarking on severalprofitable extramusical enterprises, among them asawmill and an orthopaedic clinic-well, it makessense, doesn't it?)

Lessons from Haydn rather than surgeryHenry Harington (1727-1816), after graduating MB

and MD in 1762, successfully followed a dual career as "MedicineJack"

the Duke of York and "composer andthe Bath Harmonic Society, for which hele 70 works, mostly glees. Another notedomposer was John Wall Callcott. He waslcareer in surgery, but when witnessingtion he felt so faint and terrified that heDought of further study. Instead he tooklaydn and won prize after prize from theleedless to say some of his catches harkedicine. His grandson was the composereill, a close friend of Delius who diedrng, in 1934, from the effects of a com-ior traffic accident (near the BBC) afterst aid treatment.zdicomusical member of the Catch Clubzis Hutcheson, born in Dublin in 1721v 1750) and twice president of the Royaltysicians. He managed to combine fourician, violinist, professor of chemistry atre, Dublin, and resident composer for thewhich awarded him several prizes. Heof his earlier catches with a pen name,Id. For example:octor, Oh Doctor, I'm terrify'd out ofmy wits!Daughter is fall'n into Fits.Dear Doctor, just in the Nick, etc, etc,st Step in cases like this to be sure,rein: I'll engage for a curebut give her a Prick ...

ords, the second oldest medical joke after

ymn writer John Wesley found time tonual called Primitive Physic, with variousnents for heartburn and other complaints,e and electricity. By 1830 the book had36 editions. More surprising still, thetron saint ofmalingerers himself appearsof music: there exist several sonatas by aunchhausen. Though it may have been ack, of course.common disease, hypochondria, also

usic: La Hypocondrie is the-alas un-

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explained -title of a concertante by J S Bach's contem-porary Jan Dismas Zelenka. It has recently beenrecorded on a Teldec compact disc.With so much dual talent it is hardly surprising to

learn that at the 1932 meeting of the Canadian MedicalAssociation a Dr Forde McLoughlin conductedhis own work, Influenza, A Tone Poem. Could anyCanadian reader tell us more about this occasion orprocure a copy? As recently as 1948 Dr Herman MParris produced, with the Doctors' Orchestral Societyof New York, a 10 movement orchestral suite, TheHospital, with movements entitled Anaesthesia (presto),A Nurse (allegro amabile), and a Pre-operation Prayer.Does the event figure in the society's annals?

Blow by blow descriptionBut there is nothing new. The French viol virtuoso

and composer Marin Marais celebrated an "operationfor the stone" with his Lithotomy Sonata for viola dagamba and harpsichord, which gives a blow by blowmusical description of the operation together with arunning commentary:The Patient mounts the Operating TableHe takes fright, and tries to get down again.His limbs are restrained with silken Cords.The Incision.The Blood Flows.The Cords are untied and the Patient is put to Bed to recover.Dance of Relief and Rejoicing.

The dance of relief and rejoicing was presumablyperformed by surgeon and staff, not the patient.Samuel Pepys would have loved it, for in 1658 (whenMarais was a child) he suffered an operation for theremoval of a kidney stone and thereafter celebrated itssuccessful outcome with an annual "stone feast."

Victorian doctors and their patients, pharmacists,and patent medicine manufacturers often figuredin ballads and music hall songs, which from themid-nineteenth century, thanks to cheap colourlithography, resulted in a great abundance of delight-fully illustrated sheet music. Although sex was stilltaboo suggestiveness was permitted, and songs aboutdoctors, ailments, cures, remedies, and popular health

.i ... .. . .;.'... ,, '::.;.::

Z U

...

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"The Quack's Song"

crazes were always popular. They were sometimesissued as barely disguised "commercials"-forexample, Phrenology-a New Song Dedicated to theHeads of the Universities, Public Schools and PrivateFamilies, Ipecacuanha, Morrison's Pills, or MrsWinslow's Soothing Syrup, which the young EdwardElgar immortalised in one of his works-a veritableprocession of musicomedical social history. Somesongs even managed to offer primitive health educa-tion with the help of music, like The Hygeia Waltzand The Death of King Dirt-a Domestic Revolution,being a parody on the popular ballad, The DeathofNelson.

The pictures in thearticle are from FritzSpiegl's collection.They form part of a"Spieglers"entertainment- TheMedical Muse: Songs,Verse, and Prose forDoctors and TheirPatients.

"Human guinea pigs" -a history

M H Pappworth

In 1962 I was approached by the editor of TwentiethCentury (a now defunct literary magazine) to contributeto a special number entitled "Doctors in the Sixties."My article, called "Human Guinea Pigs: A Warning"appeared in the autumn of 1962, describing 14 experi-ments in lay language; no names were named andjournal references were not given. This was an earlyevent in the debate in Britain about human experi-mentation. The debate excited much interest in boththe lay and medical press and led eventually tothe establishment of local medical research ethicscommittees.The reasons why I chose to write on this subject were

several: firstly, several of my postgraduate students,especially whenever I mentioned recent supposedmedical advances, told me about unethical experimentsthat they had personally observed in British hospitalsin which they were either junior staff or attendingcourses. Some told me of their dilemma whether or notto take an active role, or even a passive one, inpersuading a patient to volunteer, knowing that non-cooperation might jeopardise their careers. For many

years as a background to my tutorials for the MRCP Ihad spent hours in the Royal Society of Medicinelibrary scanning journals in which experiments inhumans were described that seemed to be unethicaland sometimes illegal.A further concern was that promotion in teaching

hospitals depended primarily not on clinical or teachingability but on published work. As Beecher wrote,"Every young man knows that he will never bepromoted unless he has proved himself as an investi-gator."' So whenever I read an account of an unethicalexperiment I wrote a letter to the journal protesting,often as not to have it rejected. Medical research hadbecome sacrosanct, based on the dubious dogma thatits continuation must be the prime concern of teachinghospitals.

Press reactionsMost of the popular press reported the article with

banner headlines and there were many letters from laypeople and doctors either condemning or congratulat-

London NW3 lAXM H Pappworth, MD, retired

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