395
Physiological Abstracts, which covers the whole
field of medical science with the exception of purely
clinical papers, published 14,000 abstracts last year ;
I doubt if the papers left out would be as numerous.
AIII receives a subsidy of less than E2000 from the
scientific bodies sponsoring it. It costs only :f3 5s.
per annum (the cost of the German equivalent which
publishes the same number of abstracts is about
30) and copies are presented for nothing or for a
nominal sum to the members of certain associated
learned societies. An annual subsidy of say 1:3000
for three years should put Medical Abstracts success-
fully on its scientific and financial feet.
As a practical proposal, I suggest that the Royal
College of Physicians should take- the lead and set
up a committee to consider the problem. The
committee might consist of representatives of the
Royal Colleges, the Royal Societyof Medicine, certain
of the learned societies, the Medical Research Council
and the Bureau of Chemical and Physiological
Abstracts. A workman-like scheme ought to emerge
from their deliberations in a comparatively short time.
I am, Sir, yours faithfully,
SAMSON WRIGHT.
Department of Physiology, Middlesex Hospital
Medical School, W.1, Aug. 6.
SIR,-With reference to the leading article in your
issue of Aug. 5, the problem of how to keep abreast
of published information faces workers in other
branches of science in Great Britain. It is interesting
to see how they attempt to solve it. For the sciences
touching agriculture there is in this country a chain
of Imperial Agricultural Bureaux, which act as
information centres, and publish abstract-journals
covering practically all scientific information on
agriculture. For chemistry there exists a Bureau of
Chemical Abstracts which publishes the British
Chemical Abstracts running to some 2500 large quarto
pages in each year and noticing over 25,000 papers.
The Imperial Agricultural Bureaux are jointly
financed and controlled by the governments of the
British Empire and are given facilities for their work
by the well-known research stations with which they
are closely associated. The Bureau of Chemical
Abstracts is closely associated with the Chemical
Society and the Society of Chemical Industry, and
the journals acquired by these two great societies
are put first at its disposal for abstracting.
If one may judge from these experiences, it should
be possible, given the willing cooperation of the
great medical societies, to provide a satisfactory
abstracting service for medical literature at a not
too prohibitive cost to subscribers. In those fields in
which the need for abstracting services has been met
by British effort, the cost to subscribers of the
abstract-journals is much lower than that of their
German equivalents. For example, the cost to a
subscriber of the eleven British abstract-journals
covering the science of agriculture is about :f:17 a
year compared with some n 60 for the eleven German
abstract-journals dealing with clinical medicine, and
in the medical field the British Tropical Diseases
Bulletirc, for which there is no German equivalent,
and the Bulletin of Hygiene each costs only ElIs. a
year compared with about E12 a year charged for the
German Zentralblatt fiir die gesamte Hygiene.
I am,
Sir, yours faithfully,
R. L. SHEPPARD,
Secretary, Bureau of Hygiene and
Tropical Diseases.
INSULIN RESISTANCE
SiR,—I regret that absence from London has delayed
my reply to Professor De Wesselow and Dr. Griffiths
writing in your issue of July 29. The term " insulin
resistance " is, as they say, ill-defined, being used to
include both cases in which enormous doses of insulin
appear to be without clinical effect and also cases
showing only a relative resistance to insulin. Until
we possess more knowledge it would seem advisable
to use a different term for either group of cases. It
was for this reason that in my original paper on
insulin-insensitive diabetics (Lancet, 1936, 1, 127
I suggested that the term insulin-resistant should
continue to be used for, but be confined to, those
rare cases in which large doses of insulin appeared
clinically ineffective, reserving the term insulin-
insensitive for those common cases of diabetes in
which the impairment of insulin action can only be
detected by special tests. Unfortunately the advan-
tage of such a distinction was not then appreciated.
De Wesselow and Griffiths state that using the
insulin-glucose test they have found every gradation
from insulin-sensitive to " insulin-resistant " responses.
It is necessary to make clear, however, that their
results were not obtained by using the original insulin-
glucose test but by a modification of this test which
they introduced. The insulin-glucose test, as I
described it originally, requires ten blood samples ;;.
their modification makes use of only three. As the
insulin-glucose curve tends to be irregularly S-shaped
I cannot accept their opinion that "two samples
taken half and one hour after administration of
glucose and insulin ... obviously suffice to determine
the general direction of the curve...." It is possible
to find the preliminary, the half- and the one-hour
samples all of approximately the same blood-sugar
content. Under such circumstances the insulin-
glucose curve might have ranged from shapes showing
marked sensitivity to insulin to shapes showing
moderate insulin insensitivity. Using the original
insulin-glucose test with ten samples Kerr and I
(Clin. Sci. in press) obtained data showing the
existence of two clearly demarcated types of response.
From these same data, but taking into account only
the three samples required by the De Wesselow-
Griffiths test, we recalculated the results but now
we could find no significant differentiation into two
types. We concluded that, save in extreme cases,
the De Wesselow-Griffiths test fails to distinguish
between the two types of response, and that this
failure is due to infrequent blood sampling.
I am sorry Professor De Wesselow and Dr. Griffiths
consider I have misinterpreted Dr. Griffiths in credit-
ing him with having " found a difference in the
peripheral insulin effect in the two types of sufficient
magnitude to afford support for this contention "
(that the essential difference between the two types
of response lies in a difference in the peripheral action
of insulin). I can find no statement in my paper
which, taken alone or in conjunction with its context,
carries this suggestion. The only reference to this
work of Dr. Griffiths reads, " Griffiths finds the peri-
pheral effect of insulin reduced in all diabetics but
more so in insensitive than in sensitive cases." This
is a statement of Griffiths’s published results (Clin.
Sci. 1938, 3, 91), not an interpretation.
Finally, Sir, may I draw your readers’ attention to
an error in fig. 7 of my paper which had escaped my
notice. The time figures should read 0, 10, 30, 50 min.,
not 0, 10, 20, 30 min.-I am, Sir, yours faithfully,
H. P. HIMSWORTH.
University College Hospital Medical School, Aug. 5.