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EXCRETION OF DEHYDROEPIANDROSTERONE IN NORMAL PREGNANCY AND TOXÆMIA OF PREGNANCY
317 HUMAN BIOLOGY IN GENERAL UNIVERSITY EDUCATION SIR,-Dr. J. M. Tanner (Aug. 1) paints in glowing terms the advantages of a general course in human biology as a basis for the education of persons entering a great variety of professions (teachers, politicians,
businessmen, administrators, &c.)
as well as our own. think the educational value of such courses underrated; and I am sure they could be most valuable in reconciling the Two Cultures. However, I believe Dr. Tanner (and indeed the Working Party on the School of Medicine and Human Biology) are wrong in suggesting that a general course in human biology can be devised which is at the same time suitable for all these groups and is a complete preclinical education for medical students. The bases of medicine (whatever these " may be) may lie in biology, in the study of behaviour and the organisation of communities of all sorts " and not in anatomy and physiology: none the less medical Fig. 1-Blood-uric-acid level and urinary 17-ketosteroid and D.H.A. students have got to know some anatomy and physiology, excretion of healthy pregnant women and patients with late toxaemia of pregnancy. and it is my opinion (and that of many of my colleagues) that they still need to know more of these subjects than would be appropriate for, say, a budding politician reading human biology. A knowledge of the position and functioning of the thoracic and abdominal viscera will continue to be of more value to a medical student entering hospital than a knowledge of the behaviour of communities; a knowledge of the general anatomy and physiology of the gonads more valuable than a detailed knowledge of cytogenetics. I believe that the widespread adoption of such courses as human biology for medical students will soon lead to a rapid volte-face once the clinicians discover that the burden of preclinical teaching of anatomy and physiology has been thrust upon them. Lest I be immediately dubbed reactionary, I hasten to add that my principal research interests have been in quantitative methods in biology, and in cytogenetics, and that I do believe that medical students should be taught rather more than they are of such subjects; but not at the expense of the subjects which have been the backbone of medical education for so long. For the record I am an ex-member of the school whose unbalanced Fig. 2-Urinary excretion of 17-ketosteroids and D.H.A. in a patient with late toxaemia of pregnancy, before and after delivery. output so horrifies Dr. Tanner!
I do can be
not
Anatomy School,
E. H. R. FORD.
Cambridge
EXCRETION OF DEHYDROEPIANDROSTERONE IN NORMAL PREGNANCY AND TOXÆMIA OF PREGNANCY
SIR,-The changes in lipid and purine metabolism during normal pregnancy and late toxaemia are well known.
Dehydroepiandrosterone (D.H.A.), the inhibitor glucose-6-phosphatase, interferes also with the synthesis of purine and of cholesterol. Therefore we have studied the excretion of D.H.A. in the urine3 of healthy pregnant women and patients with late toxaemia. of
the excretion of
D.H.A. we can divide our two groups: the first group (nine patients) had no D.H.A. in the urine, and the second group (five patients) had D.H.A. in the urine. There was no notable difference between the two groups in the
According
to
patients with clinical signs of toxaemia into
clinical signs of toxaemia, the severity of hypertension, or the results of urinalysis. There was, however, a difference in the blood-uric-acid level: this level (colorimetric method with 1. 2. 3.
Kotásek, A. Pozdní gestóza. Prague, 1961. Marks, F. A., Banks, J. J. clin. Invest. 1960, 39, 1010. &Sbreve;onka, J., Gregorová, I., Slabochova, Z., Rath, R. Endokrinologie, 1963,
45,
115.
acid 4) averaged 5-34 mg. per 100 ml. in the first group and 3-17 mg. per 100 ml. in the second group. In the urine of 7 out of 8 healthy pregnant women D.H.A. was lacking, but these women had a normal blood-uric-acid level
phosphotungstic
(see fig. 1). As a contribution to the character of the absence of D.H.A. in the urine of patients with late toxsemia, we show (fig. 2) our findings in a 33-year-old tertipara. During the period of toxaemia we twice observed a lack of D.H.A. in the urine, but with a normal amount of total neutral 17-ketosteroids. In the first week after delivery, this patient excreted 2 mg. of D.H.A. per 24 hours and in the 14th week 2-5 mg. per 24 hours. Her defect of D.H.A. in the final stages of pregnancy therefore seems to have been transitory and perhaps regulatory, closely connected with a broader spectrum of hormonal changes in pregnancy.
The character of all these changes, both in healthy pregnant women and in patients with late toxaexnia of pregnancy, is to be investigated in greater detail. Department of Gynæcology and Obstetrics, Brandys nad Labem. Research Laboratory for Endocrinology and Metabolism, Third Medical Clinic of the Charles University, Prague, Czechoslovakia. 4. Yi-Yung Hsia, D. Inborn Errors of Metabolism;
V. KÖLBLOVÁ I. GREGOROVÁ F. KÖLBEL
J. &Sbreve;ONKA. p. 286. Chicago, 1959.
businessmen, administrators, &c.)
as well as our own. think the educational value of such courses underrated; and I am sure they could be most valuable in reconciling the Two Cultures. However, I believe Dr. Tanner (and indeed the Working Party on the School of Medicine and Human Biology) are wrong in suggesting that a general course in human biology can be devised which is at the same time suitable for all these groups and is a complete preclinical education for medical students. The bases of medicine (whatever these " may be) may lie in biology, in the study of behaviour and the organisation of communities of all sorts " and not in anatomy and physiology: none the less medical Fig. 1-Blood-uric-acid level and urinary 17-ketosteroid and D.H.A. students have got to know some anatomy and physiology, excretion of healthy pregnant women and patients with late toxaemia of pregnancy. and it is my opinion (and that of many of my colleagues) that they still need to know more of these subjects than would be appropriate for, say, a budding politician reading human biology. A knowledge of the position and functioning of the thoracic and abdominal viscera will continue to be of more value to a medical student entering hospital than a knowledge of the behaviour of communities; a knowledge of the general anatomy and physiology of the gonads more valuable than a detailed knowledge of cytogenetics. I believe that the widespread adoption of such courses as human biology for medical students will soon lead to a rapid volte-face once the clinicians discover that the burden of preclinical teaching of anatomy and physiology has been thrust upon them. Lest I be immediately dubbed reactionary, I hasten to add that my principal research interests have been in quantitative methods in biology, and in cytogenetics, and that I do believe that medical students should be taught rather more than they are of such subjects; but not at the expense of the subjects which have been the backbone of medical education for so long. For the record I am an ex-member of the school whose unbalanced Fig. 2-Urinary excretion of 17-ketosteroids and D.H.A. in a patient with late toxaemia of pregnancy, before and after delivery. output so horrifies Dr. Tanner!
I do can be
not
Anatomy School,
E. H. R. FORD.
Cambridge
EXCRETION OF DEHYDROEPIANDROSTERONE IN NORMAL PREGNANCY AND TOXÆMIA OF PREGNANCY
SIR,-The changes in lipid and purine metabolism during normal pregnancy and late toxaemia are well known.
Dehydroepiandrosterone (D.H.A.), the inhibitor glucose-6-phosphatase, interferes also with the synthesis of purine and of cholesterol. Therefore we have studied the excretion of D.H.A. in the urine3 of healthy pregnant women and patients with late toxaemia. of
the excretion of
D.H.A. we can divide our two groups: the first group (nine patients) had no D.H.A. in the urine, and the second group (five patients) had D.H.A. in the urine. There was no notable difference between the two groups in the
According
to
patients with clinical signs of toxaemia into
clinical signs of toxaemia, the severity of hypertension, or the results of urinalysis. There was, however, a difference in the blood-uric-acid level: this level (colorimetric method with 1. 2. 3.
Kotásek, A. Pozdní gestóza. Prague, 1961. Marks, F. A., Banks, J. J. clin. Invest. 1960, 39, 1010. &Sbreve;onka, J., Gregorová, I., Slabochova, Z., Rath, R. Endokrinologie, 1963,
45,
115.
acid 4) averaged 5-34 mg. per 100 ml. in the first group and 3-17 mg. per 100 ml. in the second group. In the urine of 7 out of 8 healthy pregnant women D.H.A. was lacking, but these women had a normal blood-uric-acid level
phosphotungstic
(see fig. 1). As a contribution to the character of the absence of D.H.A. in the urine of patients with late toxsemia, we show (fig. 2) our findings in a 33-year-old tertipara. During the period of toxaemia we twice observed a lack of D.H.A. in the urine, but with a normal amount of total neutral 17-ketosteroids. In the first week after delivery, this patient excreted 2 mg. of D.H.A. per 24 hours and in the 14th week 2-5 mg. per 24 hours. Her defect of D.H.A. in the final stages of pregnancy therefore seems to have been transitory and perhaps regulatory, closely connected with a broader spectrum of hormonal changes in pregnancy.
The character of all these changes, both in healthy pregnant women and in patients with late toxaexnia of pregnancy, is to be investigated in greater detail. Department of Gynæcology and Obstetrics, Brandys nad Labem. Research Laboratory for Endocrinology and Metabolism, Third Medical Clinic of the Charles University, Prague, Czechoslovakia. 4. Yi-Yung Hsia, D. Inborn Errors of Metabolism;
V. KÖLBLOVÁ I. GREGOROVÁ F. KÖLBEL
J. &Sbreve;ONKA. p. 286. Chicago, 1959.