- Email: [email protected]
INFECTION AS A CAUSE OF DIABETES MELLITUS.
36 The added advantage of stimulating local effort. difficulties of coordinating health organisation in post-war Austria are well described ; the independence of the nine provinces, with feudal traditions suddenly overthrown but still in the minds of the people, and the shattered economic situation, make this no easy field for health work. The character of the Austrians, however, lends them stability in their disorganised environment. They are receptive, and readily inclined to take an intelligent interest in fresh views, while the autocratic Government to which they were formerly accustomed has made them amenable to direction and guidance ; for example, the patients attend unquestioningly at the clinics on the date fixed by the doctor. But the intensely local patriotism of each province makes any central organisation impracticable at the present time. Medical assistance for the sick child after the war was obtainable in Austria. by means of several different agencies. One way was through the health insurance societies, or Krankenkassen, which provided treatment for the families of their members ; another was through private child health stations instituted and run by doctors ; a third was through the city health stations, or Jugendamter, with which there came to be associated after the war a group of trained workers called the Fiirsorgerinnen. The functions of these home workers cannot be exactly matched elsewhere ; they combine advice on child welfare to the mothers with a knowledge of standardised procedure in social problems ; that is to say, they arrange for State care of illegitimate and orphan children where necessary, and for reception into institutions of tuberculous or mentally defective cases. Their influence among the peasantry is large, and has been of great assistance in solidifying the new health schemes which the Commonwealth Fund has helped to set For every province the reorganisation of on foot. child health work had to be approached in a different manner. The report gives a detailed account of the various methods employed and the results obtained. The aim has been throughout to exert a unifying influence, and the Fund has done much to coordinate the work of the health centres in each province, to promote a friendly spirit between the staffs of the different clinics, and to provide facilities for foreign travel and instructional courses for the workers. This has had an encouraging effect on the general efficiency of the service, and has greatly stimulated the interest of those engaged in it. Gifts of equipment have been made by the Fund, and assistance given in improving old quarters or obtaining new ones. This cooperation has helped considerably to relieve the post-war depression in the Austrian medical service. ____
INFECTION AS A CAUSE OF DIABETES MELLITUS. THE eetiology of diabetes mellitus remains a problem of great complexity. The classical experiments of Minkowski and von Mering1 on the effects of pancreatectomy and the isolation of insulin indicate that the essential defect is an inadequate supply of the pancreatic hormone. Many factors, however, are known to be capable of thus adversely affecting the secretion of insulin, and diabetes must be regarded, not as a morbid entity, but as the end-result of a variety of pathological processes. In a minority of cases the chain of events is relatively simple. In the diabetes which sometimes complicates hyperthyroidism, for example, it is probable that over-activity of the thyroid leads to over-stimulation, followed by exhaustion, of the 13 cells of the islets of LangerIn the hans. great majority of cases of diabetes, however, the damaging agent is not obvious. At a recent meeting of the Pathological Society of Manchester Dr. T. H. Oliver and Dr. G. J. Langley discussed the possibility that diabetes is sometimes 1 Minkowski and
von
1889-90, xxvi., 371.
Mering : Arch. f. Exp. Path.
u.
Pharm.,
There is much circumstantial evidence in favour of this view. Various bacterial and allied poisons, such as diphtheria toxin (Tisdall, Drake, and Brown 2), typhoid vaccine, and histamine are known to lower carbohydrate tolerance in animals, and in human. diabetes coincident infection very
infectious in origin.
frequently
causes a
temporary
or even a
permanent
insulin, and often precipitates coma. Dental sepsis is almost universal in diabetic patients, but, while it is attractive to attribute diabetes to continued absorption of bacterial toxins from the teeth sockets, it must not be forgotten decrease
in
the
response
to
that the dental infection may be the result of that lowered resistance to bacterial invasion which is In young subjects diabetes common to all diabetics. occasionally follows an acute infectious disease such as mumps, and in many cases of acute diabetes the onset of the symptoms can be traced to an indefinite febrile illness. These considerations haveled many observers (cf. Frissell and Hajek 3) to suggest an infectious origin in such cases. Bergey’s claim4 to have isolated from diabetic urine a filter-passing virus capable of producing glycosuria in rabbits does not appear to have been substantiated, but a virus infection, analogous to mumps, may well be concerned. If this is so, since diabetes is not contagious, the virus must be widespread and, like the virus of febrile herpes, must remain latent until activated by some other infection. Infection undoubtedly plays some part in the production of diabetes ; how large a part this is
remains uncertain. ____
A RELIABLE TEST FOR PREGNANCY.
week, in recording inconclusive though encouraging results of attempts to get clinical improvement by injections of oestrin, we had occasion to regret that the sexual cycle in man has no exact parallel LAST
in the animal world. In this issue of THE LANCET Dr. H. Allan and Dr. F. Dickens show that man’s peculiarities in this respect can sometimes be exploited to good advantage. If the pregnancy test devised by Zondek and Aschheim had been tried out on domestic animals, such as cows, where early knowledge of impregnation would be of great value to dairy farmers, it might easily have been dismissed as worthless ; in the few pregnant animals tested-cows, cats, and rabbits-the results obtained were negative. Fortunately the urine of pregnant women appears to contain a hormone which, when injected into immature mice, produces changes in the ovary that can mostly be recognised macroscopically. This hormone is not cestrin, which is also present in the urine and, as our Berlin correspondent reports, may be obtained from this source in an extraordinary state of purity. CEstrin, however, produces no such change in the ovaries, though it has an effect on the development of the immature uterus and vagina. Zondek and Aschheim believe the active hormone to be anterior
pituitary. From the clinical point of view the important fact is that critical observers such as those working at the Courtauld Institute of Biochemistry of the Middlesex Hospital, under Prof. E. C. Dodds, have found that among 126 women known to be pregnant 122 gave a positive test, while only 1 out of 82 nonpregnant women did so. Moreover, the patients selected were at an early stage of pregnancy when clinical diagnosis is still difficult. The test seems to be sufficiently reliable for all clinical purposes, and has the further advantage that in delicate circumstances it can be done without the knowledge of the patient or her friends. The technique needs practice, but is likely to be acquired by clinical pathologists now that the value of the test has been 2 Tisdall, F. F., Drake, T. G. H., and Brown, A. : Amer. Jour Dis. Children, 1926, xxxii., 854. 3 Frissell, L. F., and Hajek, J. : Arch. Int. Med., 1924, xxxiii. 230. 4 Bergey, D. H. : Proc. Soc. of Exper. Biol. and Med., 1926. xxiv., 229.
INFECTION AS A CAUSE OF DIABETES MELLITUS. THE eetiology of diabetes mellitus remains a problem of great complexity. The classical experiments of Minkowski and von Mering1 on the effects of pancreatectomy and the isolation of insulin indicate that the essential defect is an inadequate supply of the pancreatic hormone. Many factors, however, are known to be capable of thus adversely affecting the secretion of insulin, and diabetes must be regarded, not as a morbid entity, but as the end-result of a variety of pathological processes. In a minority of cases the chain of events is relatively simple. In the diabetes which sometimes complicates hyperthyroidism, for example, it is probable that over-activity of the thyroid leads to over-stimulation, followed by exhaustion, of the 13 cells of the islets of LangerIn the hans. great majority of cases of diabetes, however, the damaging agent is not obvious. At a recent meeting of the Pathological Society of Manchester Dr. T. H. Oliver and Dr. G. J. Langley discussed the possibility that diabetes is sometimes 1 Minkowski and
von
1889-90, xxvi., 371.
Mering : Arch. f. Exp. Path.
u.
Pharm.,
There is much circumstantial evidence in favour of this view. Various bacterial and allied poisons, such as diphtheria toxin (Tisdall, Drake, and Brown 2), typhoid vaccine, and histamine are known to lower carbohydrate tolerance in animals, and in human. diabetes coincident infection very
infectious in origin.
frequently
causes a
temporary
or even a
permanent
insulin, and often precipitates coma. Dental sepsis is almost universal in diabetic patients, but, while it is attractive to attribute diabetes to continued absorption of bacterial toxins from the teeth sockets, it must not be forgotten decrease
in
the
response
to
that the dental infection may be the result of that lowered resistance to bacterial invasion which is In young subjects diabetes common to all diabetics. occasionally follows an acute infectious disease such as mumps, and in many cases of acute diabetes the onset of the symptoms can be traced to an indefinite febrile illness. These considerations haveled many observers (cf. Frissell and Hajek 3) to suggest an infectious origin in such cases. Bergey’s claim4 to have isolated from diabetic urine a filter-passing virus capable of producing glycosuria in rabbits does not appear to have been substantiated, but a virus infection, analogous to mumps, may well be concerned. If this is so, since diabetes is not contagious, the virus must be widespread and, like the virus of febrile herpes, must remain latent until activated by some other infection. Infection undoubtedly plays some part in the production of diabetes ; how large a part this is
remains uncertain. ____
A RELIABLE TEST FOR PREGNANCY.
week, in recording inconclusive though encouraging results of attempts to get clinical improvement by injections of oestrin, we had occasion to regret that the sexual cycle in man has no exact parallel LAST
in the animal world. In this issue of THE LANCET Dr. H. Allan and Dr. F. Dickens show that man’s peculiarities in this respect can sometimes be exploited to good advantage. If the pregnancy test devised by Zondek and Aschheim had been tried out on domestic animals, such as cows, where early knowledge of impregnation would be of great value to dairy farmers, it might easily have been dismissed as worthless ; in the few pregnant animals tested-cows, cats, and rabbits-the results obtained were negative. Fortunately the urine of pregnant women appears to contain a hormone which, when injected into immature mice, produces changes in the ovary that can mostly be recognised macroscopically. This hormone is not cestrin, which is also present in the urine and, as our Berlin correspondent reports, may be obtained from this source in an extraordinary state of purity. CEstrin, however, produces no such change in the ovaries, though it has an effect on the development of the immature uterus and vagina. Zondek and Aschheim believe the active hormone to be anterior
pituitary. From the clinical point of view the important fact is that critical observers such as those working at the Courtauld Institute of Biochemistry of the Middlesex Hospital, under Prof. E. C. Dodds, have found that among 126 women known to be pregnant 122 gave a positive test, while only 1 out of 82 nonpregnant women did so. Moreover, the patients selected were at an early stage of pregnancy when clinical diagnosis is still difficult. The test seems to be sufficiently reliable for all clinical purposes, and has the further advantage that in delicate circumstances it can be done without the knowledge of the patient or her friends. The technique needs practice, but is likely to be acquired by clinical pathologists now that the value of the test has been 2 Tisdall, F. F., Drake, T. G. H., and Brown, A. : Amer. Jour Dis. Children, 1926, xxxii., 854. 3 Frissell, L. F., and Hajek, J. : Arch. Int. Med., 1924, xxxiii. 230. 4 Bergey, D. H. : Proc. Soc. of Exper. Biol. and Med., 1926. xxiv., 229.