Robert Daniel Lawrence

Robert Daniel Lawrence (1892-1968), always known as Robin, was born and educated in Aberdeen but spent the whole of his working life at King’s College Hospital, London where he started as a casualty officer in 1921. His ambition was to be a surgeon and while practising a mastoid operation in the post-mortem room, a splinter of bone flew into his eye; the subsequent infection led to the discovery of glycosuria. Faced with the prospect of death in a year or two, he went into general practice in Florence to spare his family the distress of his slow death and to spend his last days in beautiful surroundings. In 1923 in response to a telegram from the biochemist G.A.Harrison telling him about the discovery of insulin, he drove across Europe and reached King’s in severe ketosis on May 23rd 1923.

Professionally, Lawrence did in England what Elliot Joslin did in the USA – shaped the clinical management of diabetes for nearly 40 years. [1] Like Joslin, he put patients centre stage and insisted that they were in charge of looking after their disease. Unlike most physicians who treated diabetes at London teaching hospitals he was a hands on doctor who talked to patients in language they could understand and set them achievable targets. Having diabetes himself meant that he indulged in personal crusade to improve the lives of diabetics with whom he felt a deep kinship. In 1925, he produced the first edition of the enduringly popular and practical patient manual, The Diabetic Life: Its control by diet and insulin, which reached its 17th edition in 1965 and was translated into many languages.

His first 10 papers were published between 1924 and 1927, and included the results of self experimentation. In those early days he was quoted as saying: "a day was wasted when I didn't do an experiment on myself, patient, or animal. I had a demon passion for work." In 1925 he devised a line diet which was an ingenious way of explaining the principles to those who would have been baffled by grammes and calories. The diabetic clinic which he founded at King’s soon became the mecca for diabetics in England. Lawrence himself did more than his share of the work and in an obituary it was said that he ‘seemed to know all the patients by name and to be acquainted with the personal problems of most of them.’ His approach to the management of diabetes was essentially practical and in the 1920s this was unusual since most of the physicians specialising in diabetes had been trained as biochemists and tended to be rigid and unimaginative. Lawrence himself was an extrovert, if not an outright exhibitionist.

In 1934 he conceived the idea of an association which would foster research and encourage the welfare and education of diabetics and with the assistance of his patient the writer H.G.Wells he formed the Diabetic Association (now Diabetes UK). [2] He was also the first president of the International Diabetes Federation from 1950 to 1958.

After 1930 Lawrence’s publications were mainly clinical. One exception is his work with Joseph Bornstein which proved that juvenile onset diabetics were insulin deficient while maturity onset diabetics had detectable levels of insulin. [3]The disease lipoatrophic diabetes was named and the classical case reported by Lawrence in 1946. [4] He thought the clue to the pathogenesis of this curious condition was the lipoatrophy and proposed that:

No fat could be stored in the usual depots and so it circulated in excess and produced lipaemia. The lipaemia depended directly on the level of blood sugar and disappeared repeatedly when the hyperglycaemia was controlled by enormous doses of insulin.

He went on to suggest that there might be a fat-fixing factor or hormone that his patient lacked. There are now known to be several different lipodystrophic syndromes with varying aetiologies. The acquired form that Lawrence described is called the Lawrence–Seip syndrome.

References

  1. ^ Jane Lawrence and Robert Tattersall. Diabetes, insulin and the life of RD Lawrence. Royal Society of Medicine Press, 2012.

  2. ^ Jackson, J.G.L. R.D.Lawrence and the Formation of the Diabetic Association Diabetic Medicine 1996;13: 9-22.

  3. ^ Bornstein J, Lawrence RD. Two types of diabetes, with and without available plasma insulin. Br Med J1951; i: 732.

  4. ^ Lawrence RD. Lipodystrophy and hepatomegaly with diabetes, lipaemia and other metabolic disturbances.Lancet1946; i: 724–31, 773–5.

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