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PREGNANCY IN DIABETICS
605
fabric, irreversible wetting could not occur unless the object had a high thermal capacity. Such contact appears difficult to achieve in practice. However, we have obtained good results with metal bowls by packing them in moulded cases of asbestos paper before wrapping them. Papier mache about 1/4 in. thick would probably also be suitable. In the case of the fluids steriliser, if the bottles are leaving the steriliser dry, we suppose that they are not cooled completely to room temperature and that the drops of water which to their outer surfaces can contents to evaporate.
adhere the
obtain sufficient heat from
Drying and Distillation Research Division, Edwards High Vacuum, Ltd., Crawley, Sussex.
T. W. G. ROWE R. KUSAY.
PREGNANCY IN DIABETICS SIR,-In your report of the congress of the International Diabetes Federation (July 29, p. 258), you state that " more evidence is accumulating from work on animals that maternal hyperglycsemia may prove diabetogenic to the foetus in the absence of genetic factors. Dr. W. Gepts (Anvers) described the basis for this theory." This is exactly the opposite of what I have said, and of what I have concluded from my experimental work. In the offspring of rats which had been made alloxan diabetic for 4 or 5 successive generations, I was unable to detect either a single case of spontaneous diabetes, or a reduction in glucose tolerance. The islet tissue of these rats, three months after birth, appeared to be completely normal. These findings are at variance with those reported by Okamoto and Fukutome,l and by Bartelheimer and Kloos,2 who did observe spontaneous diabetes in the offspring of alloxan diabetic rabbits and rats. In view of these contradictory findings, the possibility of maternal diabetic hyperglycaemia being diabetogenic to the foetus still seems open to question to me. W. GEPTS. INSULIN
SIR,-Your leading article (July 8) fails to clarify the hydrogen atom and the hydrogen
difference between the ion (proton).
You say: "... and two cysteine molecules readily give up their hydrogen atoms to suitable hydrogen acceptors to reunite as cystine under the catalytic influence of metal ions." You add later, " Essentially it involves the provision of energy through the catalysed transfer of hydrogen ions from primary substrates either to oxygen (as in aerobic respiration) or to a final hydrogen acceptor (as in anaerobic respiration or fermentation) ..." What happens to the hydrogen electrons ? Are they left behind with the substrate and are new electrons supplied to the itinerant protons at the end of the transport chain so that the newly formed atoms may be combusted by oxygen to produce water ? The most striking feature of diabetic coma is metabolic acidosis. When the bicarbonate stores of the blood become depleted, excretion of COby the lungs can no longer correct the tendency to acidosis and blood pH falls. The patient may then die of proton poisoning (just as patients in thyrotoxic crises may die of electron poisoning) and it is curious that a blood pH which is lower than the pH of water is seldom compatible with life. A patient in diabetic coma may sometimes be brought back to consciousness by large doses of insulin alone. Under these circumstances it would be interesting to know whether the blood pH was initially below the normal range, for then we could say that, whatever the intricate metabolism of ketosis, insulin administration had coincided with the release of electrons to neutralise the excess of protons. 1. Tôhoky J. exp. Med. 1954, 62, 61. 2. Z. ges. exp. Med. 1952, 119, 246.
"
The more we learn about insulin the less we understand it." In-vitro studies indicate that the insulin-like activity of serum from diabetic subjects is able to transport or transform glucose more readily in fat than in muscle.12 Perhaps the clinical reflection of this enigma is to be found in the observation that in young untreated diabetics muscle-wasting is prominent, whereas the diabetes of later life is more typically associated with excessive accumulation of depot fat. To treat obese diabetics with insulin is illogical; for this increases the appetite and leads to further fat synthesis, whereas the total withdrawal of carbohydrate from their diet commonly leads to weight loss and disappearance of glycosuria without further treatment.
The suggestion of Randle and Youngthat - SH proteins may play a part in the transport of sugars into muscle should not be allowed to obscure the fact that unsaturated fatty acids form part of the structure of cell membranes. Is it not conceivable that the interconversion of, say, arachidonic and linolenic acids with appropriate transport of hydrogen may also contribute to the work of shuttling molecules between the cell and its environment ?
The hearts of those who are chilled by chemical formulas may be warmed by the words of Albert SzentGy6rgyi 4: " What drives life is thus a little electric current, kept up by the sunshine. All the complexities of intermediary metabolism are but lacework around this basic fact." Canberra, Austsalia.
S. B. FURNAS . S. B. FURNASS.
FAMILY CARE OF MENTAL PATIENTS your annotation of July 22 may also to read about a Japanese Gheel at the village of
SIR,-Readers of care
Iwakura. The following description was given in 1912 by Dr. Frederick Peterson in the Bulletin of the Ontario Hospitals for the Insane (vol. 5, p. 107): " The third daughter of the Emperor Gosanjo in the eleventh century, developed melancholia in her eighteenth year. Word was brought to the imperial household that at Iwakura was a holy fountain, the water of which was healing to mental diseases and to disorders of the eyes. The emperor’s daughter was taken there nearly 900 years ago and recovered and so brought fame to the temple and the well of Iwakura, as a result of which the insane were brought there in great numbers. At first three small inns were constructed to receive them, then later tea houses and villas and cottages sprang up in which to care for the ever-increasing influx of patients. " In the year 1889 the village had 239 houses, with 1579 inhabitants, and up to that year one or two patients were received into each family to share in the occupations of the household, which were chiefly out-of-door employments in fields, gardens and forests. " In 1889 the Japanese government, evidently under the impression gained from a study of the asylum systems of Europe and America, came to the conclusion that their colony system that had grown up so naturally was too far from our Western ideals, as exemplified in our colossal caravansaries for the insane, and so forbade the insane being any longer taken to the village of Iwakura. " The result of this opposition of the government has been to reduce at least temporarily the number of insane in the colony. It is altogether likely that as soon as the authorities learn that out of themselves they have developed through nearly a thousand years the best of all methods of caring for the insane, toward which the West itself is struggling with much difficulty, they will remove the proscription and restore Iwakura to its ancient rights and privileges under State organization and inspection. There is one retreat for about 90 patients at Iwakura built on European models under the care of physicians, 1. Steinke, J., Taylor, K. W., Reynold, A. E. Lancet, 1961, i, 30. 2. Lowy, C., Blanshard, G., Phear, D. ibid. p. 802. 3. Randle, P. J., Young, F. G. Brit. med. Bull. 1960, 16, 237. 4. Szent-Gyorgyi, A. Introduction to a Submolecular Biology; p. 22. New York, 1960.
fabric, irreversible wetting could not occur unless the object had a high thermal capacity. Such contact appears difficult to achieve in practice. However, we have obtained good results with metal bowls by packing them in moulded cases of asbestos paper before wrapping them. Papier mache about 1/4 in. thick would probably also be suitable. In the case of the fluids steriliser, if the bottles are leaving the steriliser dry, we suppose that they are not cooled completely to room temperature and that the drops of water which to their outer surfaces can contents to evaporate.
adhere the
obtain sufficient heat from
Drying and Distillation Research Division, Edwards High Vacuum, Ltd., Crawley, Sussex.
T. W. G. ROWE R. KUSAY.
PREGNANCY IN DIABETICS SIR,-In your report of the congress of the International Diabetes Federation (July 29, p. 258), you state that " more evidence is accumulating from work on animals that maternal hyperglycsemia may prove diabetogenic to the foetus in the absence of genetic factors. Dr. W. Gepts (Anvers) described the basis for this theory." This is exactly the opposite of what I have said, and of what I have concluded from my experimental work. In the offspring of rats which had been made alloxan diabetic for 4 or 5 successive generations, I was unable to detect either a single case of spontaneous diabetes, or a reduction in glucose tolerance. The islet tissue of these rats, three months after birth, appeared to be completely normal. These findings are at variance with those reported by Okamoto and Fukutome,l and by Bartelheimer and Kloos,2 who did observe spontaneous diabetes in the offspring of alloxan diabetic rabbits and rats. In view of these contradictory findings, the possibility of maternal diabetic hyperglycaemia being diabetogenic to the foetus still seems open to question to me. W. GEPTS. INSULIN
SIR,-Your leading article (July 8) fails to clarify the hydrogen atom and the hydrogen
difference between the ion (proton).
You say: "... and two cysteine molecules readily give up their hydrogen atoms to suitable hydrogen acceptors to reunite as cystine under the catalytic influence of metal ions." You add later, " Essentially it involves the provision of energy through the catalysed transfer of hydrogen ions from primary substrates either to oxygen (as in aerobic respiration) or to a final hydrogen acceptor (as in anaerobic respiration or fermentation) ..." What happens to the hydrogen electrons ? Are they left behind with the substrate and are new electrons supplied to the itinerant protons at the end of the transport chain so that the newly formed atoms may be combusted by oxygen to produce water ? The most striking feature of diabetic coma is metabolic acidosis. When the bicarbonate stores of the blood become depleted, excretion of COby the lungs can no longer correct the tendency to acidosis and blood pH falls. The patient may then die of proton poisoning (just as patients in thyrotoxic crises may die of electron poisoning) and it is curious that a blood pH which is lower than the pH of water is seldom compatible with life. A patient in diabetic coma may sometimes be brought back to consciousness by large doses of insulin alone. Under these circumstances it would be interesting to know whether the blood pH was initially below the normal range, for then we could say that, whatever the intricate metabolism of ketosis, insulin administration had coincided with the release of electrons to neutralise the excess of protons. 1. Tôhoky J. exp. Med. 1954, 62, 61. 2. Z. ges. exp. Med. 1952, 119, 246.
"
The more we learn about insulin the less we understand it." In-vitro studies indicate that the insulin-like activity of serum from diabetic subjects is able to transport or transform glucose more readily in fat than in muscle.12 Perhaps the clinical reflection of this enigma is to be found in the observation that in young untreated diabetics muscle-wasting is prominent, whereas the diabetes of later life is more typically associated with excessive accumulation of depot fat. To treat obese diabetics with insulin is illogical; for this increases the appetite and leads to further fat synthesis, whereas the total withdrawal of carbohydrate from their diet commonly leads to weight loss and disappearance of glycosuria without further treatment.
The suggestion of Randle and Youngthat - SH proteins may play a part in the transport of sugars into muscle should not be allowed to obscure the fact that unsaturated fatty acids form part of the structure of cell membranes. Is it not conceivable that the interconversion of, say, arachidonic and linolenic acids with appropriate transport of hydrogen may also contribute to the work of shuttling molecules between the cell and its environment ?
The hearts of those who are chilled by chemical formulas may be warmed by the words of Albert SzentGy6rgyi 4: " What drives life is thus a little electric current, kept up by the sunshine. All the complexities of intermediary metabolism are but lacework around this basic fact." Canberra, Austsalia.
S. B. FURNAS . S. B. FURNASS.
FAMILY CARE OF MENTAL PATIENTS your annotation of July 22 may also to read about a Japanese Gheel at the village of
SIR,-Readers of care
Iwakura. The following description was given in 1912 by Dr. Frederick Peterson in the Bulletin of the Ontario Hospitals for the Insane (vol. 5, p. 107): " The third daughter of the Emperor Gosanjo in the eleventh century, developed melancholia in her eighteenth year. Word was brought to the imperial household that at Iwakura was a holy fountain, the water of which was healing to mental diseases and to disorders of the eyes. The emperor’s daughter was taken there nearly 900 years ago and recovered and so brought fame to the temple and the well of Iwakura, as a result of which the insane were brought there in great numbers. At first three small inns were constructed to receive them, then later tea houses and villas and cottages sprang up in which to care for the ever-increasing influx of patients. " In the year 1889 the village had 239 houses, with 1579 inhabitants, and up to that year one or two patients were received into each family to share in the occupations of the household, which were chiefly out-of-door employments in fields, gardens and forests. " In 1889 the Japanese government, evidently under the impression gained from a study of the asylum systems of Europe and America, came to the conclusion that their colony system that had grown up so naturally was too far from our Western ideals, as exemplified in our colossal caravansaries for the insane, and so forbade the insane being any longer taken to the village of Iwakura. " The result of this opposition of the government has been to reduce at least temporarily the number of insane in the colony. It is altogether likely that as soon as the authorities learn that out of themselves they have developed through nearly a thousand years the best of all methods of caring for the insane, toward which the West itself is struggling with much difficulty, they will remove the proscription and restore Iwakura to its ancient rights and privileges under State organization and inspection. There is one retreat for about 90 patients at Iwakura built on European models under the care of physicians, 1. Steinke, J., Taylor, K. W., Reynold, A. E. Lancet, 1961, i, 30. 2. Lowy, C., Blanshard, G., Phear, D. ibid. p. 802. 3. Randle, P. J., Young, F. G. Brit. med. Bull. 1960, 16, 237. 4. Szent-Gyorgyi, A. Introduction to a Submolecular Biology; p. 22. New York, 1960.