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ORGANIC CHEMISTRY
965 HEIGHTENED PERCEPTION AFTER E.C.T. SiR,-I have recently become interested in an unusual
phenomenon following
electroconvulsive
therapy (.c.T.).
hospital because of melancholia with suicidal tendencies, was given a short course of E.c.T. in the hope of relieving his symptoms. The convulsions were followed by a period of confusion which lasted about an hour. This phase was constantly succeeded by a transient phase of increased awareness of the environment, lasting some six hours. He described his feelings during this time in the following words: " Everything becomes more vivid and seems to take on a bolder outline. The sky, buildings, and even women appear more beautiful. All colours are intensified ; black objects increase in blackness, and red ones become more red. I am conscious.of a delight in life which I have not experienced for a long time. Knowing that it is temporary, I can thoroughly enjoy this period. One can go to the heights of Mont Blanc, but one cannot remain there ! Soon I drift back to my usual state of mild depression." A man, admitted to
Another
from
anxiety state with remarkable improvement in his colour-vision had followed a short course of
patient, suffering
depressive features, claimed that
E.C.T
an
a
°
The general increase in visual acuity is somewhat reminiscent of the effect produced by the sudden relief of cerebral anoxia. It can be argued that removal of depression, with its inhibiting effects, explains the augmented perception. However Lhermitte and Parchemineyand others have described hallucinosis following electro-shock, which suggests a positive increase in activity bv the sensorv cortex. J. TODD. Basingstoke, Hants. ORGANIC HYPERINSULINISM TREATED WITH ALLOXAN
SiR,-The article of Feb. 24 by Dr. Gilchrist and Dr. Lynch is worthy of note, because the level of the - serum-citric-acid in the case described is the highest I have ever heard of-i.e., about 20 times normal. This is all the more remarkable in a patient with hypoglycsemia, because I can confirm Dr. Weil-Malherbe’s observation that the serum-citrate level decreases in The urinary excretion of artificial hypoglycaemia. citric acid is said to be excessive, but it must be regarded as only moderately increased as compared with the I have observed greater urinary serum-citric-acid. excretion of citric acid per 24 hours in Addison’s disease. Unless the test was influenced by pathologically increased levels of other blood constituents, it would seem reasonable to suppose the high citric-acid level to be primarily of interest in explaining the pathogenesis. It cannot be proved with certainty that the condition was one of hyperinsulinism. It would be very remarkable if two such rare diseases as hyperplasia of the islets of Langerhans and primary liver-cell carcinoma were to occur simultaneously. The picture resembles rather that described in spontaneous hypoglycaemia as due to hepatic disease, and in very rare cases to liver cancer, but without pancreatic involvement. The decrease in the amount of liver tissue has not always been regarded as sufficient to explain hypoglycaemia or the consumption of the large quantity of glucose that had to be administered to keep the patient alive. In such cases the condition has been explained as a secondary hyperfunction of the islets of Langerhans ; this must, of course, be regarded as purely hypothetical. The possibility of changed metabolism of the large tumour masses and consequent increased consumption of glucose, together with decreased storage capacity of the liver, has also been suggested. In the case reported the markedly increased serum-citric-acid might indicate such abnormal carbohydrate metabolism. Reports of the citric-acid 1. Lhermitte, J., Parcheminey. Rev. Neurol. 1943, 75, 37.
metabolism in similar
cases
would be of interest.
Such
high figures as 53-3 mg. per 100 ml. have hitherto been recorded only in animal experiments : I have measured such levels in rabbits after the administration of guanidine or Synthalin’ ; and Peters et al. have reported similar levels in rats, guineapigs, and pigeons medicated with fluoroacetate. Medical Clinic, University of Lund, Sweden.
J. MÅRTENSSON.
ORGANIC CHEMISTRY
review last year1 of my book2 includes the SiR,-Your " comment : Scottish readers will be horrified to read that whisky is made from maize or rye, neither of which is used in the production of ’Scotch.’" I should like to point out that in the U.S.A. whisky is made almostly exclusively from maize and rye and not, as in Scotland, from barley. Your review also remarks on the neglect in my book of a description of the energetic aspects of alcoholic fermentation, including the role and production of A.T.P. This problem which has long been under investigation, involves physiological chemistry, and discussion of it has no place in a textbook of organic chemistry. ’
Chemical Institute, University of Zürich.
P. KARRER.
CATION-EXCHANGE RESINS SiB,—We have read with interest Mr. Morton’s article of April 14. As far as is known, the ion exchanges of these resins are governed by the law of mass action. According to Kressman and Kitchener3 the exchange of sodium and hydrogen ions is governed by the relation
CNa res CH res = KH/Na where CH and CNa are the concentrations of hydrogen and sodium ions in the solution in m.eq. per litre, CNa rea and CH res are the amounts (in m.eq.) of sodium and hydrogen ion per g. of resin, and KH/Na is the exchange equilibrium constant. The corresponding equation for calcium and hydrogen ions is
CH
.
_
Na
CCa res
(CH)2 -
Cc. Cpa . (cures)
2
"
KgCa
Mr. Morton’s results do not disagree with this view. For instance, in the second experiment quoted in his article, 1 g. quantities of ’Zeo-Karb ’ were allowed to react with different volumes of the same solution of sodium chloride : from the results given the value of Kjj/a. calculated for the first tube is 3-30 and for the sixth tube 3-37. The agreement is excellent. Our own preliminary investigations suggest that, employing the technique of Kressman and Kitchener, 1 g. of zeo-karb 225/H has a capacity of 5-0 m.eq. and that the exchange equilibrium constant with sodium (KH/Na) is 1.8. These results are calculated for dry resin, but air-dried resin was used in the experiments and its moisture content, determined by drying at 100-120°C for 5 hours, was found to be 31%. Mr. Morton’s deduction that 1 g. of resin equilibrated with a solution containing 6 m.eq. of sodium ion would be saturated with sodium is probably wrong ; on the basis of his own figures it seems likely that about 86% saturation would be achieved. The relation between the initial amount of sodium ion in the solution and the percentage saturation with sodium of the resin at equilibrium is a parabola. Similarly 1 g. of resin in presence " of 0-7 m.eq. of sodium would have a percentage efficiency ratio " of about 91%, and not 100% as stated. 1. Lancet, 1950, ii, 375. 2. Organic Chemistry. London, 1950. 3. Kressman, T. R. E., Kitchener, J, A.
1190, 1201.
J. chem. Soc.
1949,
phenomenon following
electroconvulsive
therapy (.c.T.).
hospital because of melancholia with suicidal tendencies, was given a short course of E.c.T. in the hope of relieving his symptoms. The convulsions were followed by a period of confusion which lasted about an hour. This phase was constantly succeeded by a transient phase of increased awareness of the environment, lasting some six hours. He described his feelings during this time in the following words: " Everything becomes more vivid and seems to take on a bolder outline. The sky, buildings, and even women appear more beautiful. All colours are intensified ; black objects increase in blackness, and red ones become more red. I am conscious.of a delight in life which I have not experienced for a long time. Knowing that it is temporary, I can thoroughly enjoy this period. One can go to the heights of Mont Blanc, but one cannot remain there ! Soon I drift back to my usual state of mild depression." A man, admitted to
Another
from
anxiety state with remarkable improvement in his colour-vision had followed a short course of
patient, suffering
depressive features, claimed that
E.C.T
an
a
°
The general increase in visual acuity is somewhat reminiscent of the effect produced by the sudden relief of cerebral anoxia. It can be argued that removal of depression, with its inhibiting effects, explains the augmented perception. However Lhermitte and Parchemineyand others have described hallucinosis following electro-shock, which suggests a positive increase in activity bv the sensorv cortex. J. TODD. Basingstoke, Hants. ORGANIC HYPERINSULINISM TREATED WITH ALLOXAN
SiR,-The article of Feb. 24 by Dr. Gilchrist and Dr. Lynch is worthy of note, because the level of the - serum-citric-acid in the case described is the highest I have ever heard of-i.e., about 20 times normal. This is all the more remarkable in a patient with hypoglycsemia, because I can confirm Dr. Weil-Malherbe’s observation that the serum-citrate level decreases in The urinary excretion of artificial hypoglycaemia. citric acid is said to be excessive, but it must be regarded as only moderately increased as compared with the I have observed greater urinary serum-citric-acid. excretion of citric acid per 24 hours in Addison’s disease. Unless the test was influenced by pathologically increased levels of other blood constituents, it would seem reasonable to suppose the high citric-acid level to be primarily of interest in explaining the pathogenesis. It cannot be proved with certainty that the condition was one of hyperinsulinism. It would be very remarkable if two such rare diseases as hyperplasia of the islets of Langerhans and primary liver-cell carcinoma were to occur simultaneously. The picture resembles rather that described in spontaneous hypoglycaemia as due to hepatic disease, and in very rare cases to liver cancer, but without pancreatic involvement. The decrease in the amount of liver tissue has not always been regarded as sufficient to explain hypoglycaemia or the consumption of the large quantity of glucose that had to be administered to keep the patient alive. In such cases the condition has been explained as a secondary hyperfunction of the islets of Langerhans ; this must, of course, be regarded as purely hypothetical. The possibility of changed metabolism of the large tumour masses and consequent increased consumption of glucose, together with decreased storage capacity of the liver, has also been suggested. In the case reported the markedly increased serum-citric-acid might indicate such abnormal carbohydrate metabolism. Reports of the citric-acid 1. Lhermitte, J., Parcheminey. Rev. Neurol. 1943, 75, 37.
metabolism in similar
cases
would be of interest.
Such
high figures as 53-3 mg. per 100 ml. have hitherto been recorded only in animal experiments : I have measured such levels in rabbits after the administration of guanidine or Synthalin’ ; and Peters et al. have reported similar levels in rats, guineapigs, and pigeons medicated with fluoroacetate. Medical Clinic, University of Lund, Sweden.
J. MÅRTENSSON.
ORGANIC CHEMISTRY
review last year1 of my book2 includes the SiR,-Your " comment : Scottish readers will be horrified to read that whisky is made from maize or rye, neither of which is used in the production of ’Scotch.’" I should like to point out that in the U.S.A. whisky is made almostly exclusively from maize and rye and not, as in Scotland, from barley. Your review also remarks on the neglect in my book of a description of the energetic aspects of alcoholic fermentation, including the role and production of A.T.P. This problem which has long been under investigation, involves physiological chemistry, and discussion of it has no place in a textbook of organic chemistry. ’
Chemical Institute, University of Zürich.
P. KARRER.
CATION-EXCHANGE RESINS SiB,—We have read with interest Mr. Morton’s article of April 14. As far as is known, the ion exchanges of these resins are governed by the law of mass action. According to Kressman and Kitchener3 the exchange of sodium and hydrogen ions is governed by the relation
CNa res CH res = KH/Na where CH and CNa are the concentrations of hydrogen and sodium ions in the solution in m.eq. per litre, CNa rea and CH res are the amounts (in m.eq.) of sodium and hydrogen ion per g. of resin, and KH/Na is the exchange equilibrium constant. The corresponding equation for calcium and hydrogen ions is
CH
.
_
Na
CCa res
(CH)2 -
Cc. Cpa . (cures)
2
"
KgCa
Mr. Morton’s results do not disagree with this view. For instance, in the second experiment quoted in his article, 1 g. quantities of ’Zeo-Karb ’ were allowed to react with different volumes of the same solution of sodium chloride : from the results given the value of Kjj/a. calculated for the first tube is 3-30 and for the sixth tube 3-37. The agreement is excellent. Our own preliminary investigations suggest that, employing the technique of Kressman and Kitchener, 1 g. of zeo-karb 225/H has a capacity of 5-0 m.eq. and that the exchange equilibrium constant with sodium (KH/Na) is 1.8. These results are calculated for dry resin, but air-dried resin was used in the experiments and its moisture content, determined by drying at 100-120°C for 5 hours, was found to be 31%. Mr. Morton’s deduction that 1 g. of resin equilibrated with a solution containing 6 m.eq. of sodium ion would be saturated with sodium is probably wrong ; on the basis of his own figures it seems likely that about 86% saturation would be achieved. The relation between the initial amount of sodium ion in the solution and the percentage saturation with sodium of the resin at equilibrium is a parabola. Similarly 1 g. of resin in presence " of 0-7 m.eq. of sodium would have a percentage efficiency ratio " of about 91%, and not 100% as stated. 1. Lancet, 1950, ii, 375. 2. Organic Chemistry. London, 1950. 3. Kressman, T. R. E., Kitchener, J, A.
1190, 1201.
J. chem. Soc.
1949,