RD Lawrence
R D Lawrence played a central role in the formation of the British Diabetic Association.
Robert, commonly known as Robin, Lawrence was born in Aberdeen on 18 November 1892. He was educated at Aberdeen Grammar School and Aberdeen University and proved an outstanding scholar and sportsman. He followed his elder brother into medical school, graduating with honours in 1916. He then joined the Royal Army Medical Corps and spent the next three years in India.
Returning home in 1919, he was fortunate in obtaining an appointment as second House Surgeon in the Casualty Department of King’s College Hospital, London, later transferring to the Ear, Nose and Throat Department.
Diabetes
Diagnosed by chance
Lawrence did not show any of the classical symptoms of diabetes, such as thirst or blurred vision, and was diagnosed by chance when admitted to hospital for a severe eye infection in 1920. He had been practising his surgery techniques on a cadaver one night when a chip of bone flew into his right eye. It became violently septic and spread to the other eye. Once treated for his diabetes, his eye infection cleared within a week, although it left permanent damage to his right eye.
The quiet life
No longer able to continue in surgery, and finding that studying hard at medicine was affecting his diabetes control, Lawrence decided to stick to the quiet life and set up a practice. Not wanting to die at home, he set up his practice in Florence, Italy.
Unsure about insulin
In the winter of 1922-1923, he developed bronchitis, which badly affected his diabetes control. In his memoirs he wrote “I couldn’t walk upstairs and I would fall down, and altogether things were getting pretty horrid”. Dr G A Harrison wrote to him telling him of the discovery of insulin in Canada, but being disillusioned by ‘quack’ remedies, Lawrence replied that he would wait and see.
By May 1923 he had developed peripheral neuritis and was finding everyday life a struggle; “I could not handle a match to light the solacing cigarette… the struggle to keep alive – it could not be called living – was no longer tolerable or worth while.”
In the nick of time
Just in time, Lawrence received a cable from Dr Harrison saying; “I’ve got some insulin. It works. Come back quick.”
Experimentation
Trying insulin
RD Lawrence arrived at the casualty ward of King’s College Hospital on 28 May 1923. After two days of testing, Harrison and Lawrence discussed the dose of insulin that should be administered to Lawrence. Neither doctor knew anything about insulin and their judgments were largely guess work. They decided that the first injection, to be given at 10am on 31 May 1923, was to be 20 units.
Hypoglycaemia
Lawrence then ate a breakfast of eggs, bacon and toast. His urine was tested hourly, showing a steady decrease in sugar and acetone. At 3pm his urine was free from sugar. However, at 4pm Lawrence started to shake and sweat and complained of an awful hunger pang. He was experiencing hypoglycaemia (low blood glucose levels). This had been observed in dogs as a result of an overdose. Lawrence had some sugar and biscuits and soon recovered.
Diabetes under control
The following morning Lawrence once again had high levels of sugar in his urine, so it was decided that he should try two injections per day. These were administered at 10am and 4pm each day, which finally brought his diabetes under control.
Invaluable contributions
By experiment, example and education, RD Lawrence liberated people with diabetes from much of the difficulty with their condition and contributed immeasurably to the clinical, scientific and socio-emotional understanding of diabetes.
Helping others take control
After being appointed Biochemist to King's College Hospital in 1923, Lawrence set up a ‘diet kitchen’ where patients could be taught as out-patients about their diets and injections. He believed ardently in people with diabetes taking control of their own treatment and that this would also improve their quality of life.
Diet schemes
To aid this he devised several influential diet schemes, such as the ‘Line-Ration Diet’, now called the Lawrence Weighed diet, and the Lawrence Unweighed Diabetic Diet, providing simple, accurate methods of measuring one's own diet.
In deriving his diet schemes he was certain to fulfil three main criteria in these diets:
- It must contain sufficient carbohydrate to prevent ketosis.
- It must satisfy the patient in quantity and quality as far as possible.
- It must be accurate, simple to calculate, and varied.
Books on diabetes
In 1925 he published the first edition of 'The Diabetic Life', and went on to publish a further 16 editions, with the 17th edition being published in 1965.
In 1929 he published the first edition of 'The Diabetic ABC', which he described as a ‘short practical book for patients and nurses’.
The Diabetic Association
In 1934 he co-founded the Diabetic Association, now known as Diabetes UK, with HG Wells.
Bibliography
Jackson, J.G.L (1996) R.D. Lawrence and the Formation of the Diabetic Association. Diabetic Medicine, 1996, 13: 9-22 John Wiley & Sons, Ltd.
Lawrence, R.D. (1965) The Diabetic Life 17th ed. J. & A. Churchill Ltd, London.
Lawrence, R.D. (1952) The Beginning of the Diabetic Association in England in Diabetes: Its Medical and Cultural History, D. Von Engelhardt (Ed) 1989, Springer-Verlag, Germany.