Sea Snails and Shock Therapy

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I was talking with my editorial advisor who has an interest in malacology. Read mollusks. Molluscollogists, even have their own journal. His particular sub speciality is cataloging sea snails while fending off bull sharks while diving off the coral reefs of the Caribbean. Everyone needs a hobby I guess.

Knowing nothing about snails beyond those served with black bean sauce I found out that the marine version kills it’s prey by insulin shock -a hypoglycemic coma. This rekindled my interest in the history of “shock therapies” starting with insulin coma. A Polish MD named Sakel came up with this idea in 1927 after he accidentally gave one of his diabetic patients an insulin overdose, and it sent her into a coma. What could have been a juicy malpractice suit turned into a triumph  as the patient, a drug addict, woke up and declared her morphine craving gone.”My supposition was that some noxious agent weakened the resilience and the metabolism of the nerve cells leading to a reduction in the energy spending of the cell. This invoked a minor or greater hibernation in it, by blocking the cell off with insulin which will force it to conserve functional energy and store it to be available for the reinforcement of the cell.” Makes perfect sense.

Nevertheless insulin coma therapy was claimed to be >70% effective in treating schizophrenia and was the first bio therapy for this debilitating condition. One of its recipients was Zelda Fitzgerald. The treatments however required as many as 50 or more insulin induced comas, intense nursing care and the remissions were short lived, plus 2% of patients died. Thus it fizzled out by the early 60’s coincident with the greater utility of phenothiazine drugs. How it worked is unknown as is true of the many so called “shock therapies.”

Not so with malaria therapy introduced by an Austrian physician named von Jauregg.
He observed that insane patients improved considerably after surviving severe typhoid fever or tuberculosis infections. Impressed by the coincidence that all of these patients had episodes of high fever, he started to do experiments with many methods of inducing fever, such as infection by erysipelas, injections of tuberculin, typhoid, etc. without much success.

That is until he tried the idea out on patients with neurosyphilis. In 1917 Wagner-Jauregg inoculated nine chronic syphilitic patients with the tainted blood of a soldier who had malaria. This could be treated with quinine, and the high fever killed off the treponema organism responsible for syphilis. Neat idea actually exchanging one parasite for another and then knocking out both. The problem was that 15% of patients died. Later penicillin dealt malaria therapy a final death blow.

Von Juaregg won the noble prize for this in 1927. However he also believed schizophrenia was a result of excessive masturbation so he sterilized the afflicted, resulting in an “improved” condition. He later joined the Nazi party and was President of the Austrian League for Racial Regeneration and Heredity, which advocated sterilization for those of inferior genetics. Fortunately he died in 1940.

Our last shock treatment is the convulsive type currently in use as ECT-electro convulsive therapy. This originally started out as a chemical induction. In 1934 a  pathologist  von Meduna reasoned that, because schizophrenia was rare in epileptics, and because epileptics seemed blissfully happy after seizures, then it seemed logical that giving schizophrenics seizures would make them calmer and depressives happier.

In order to do this he tested several  seizure-inducing drugs like strychnine, caffeine, and absinthe,  before settling on metrazol, a stimulant of sorts.  And although he claimed the treatment cured the majority of his patients, opponents argued that the method was dangerous and poorly understood and was supplanted by ECT in the late 1930’s.

Despite bad press and dramatic  portrayals in One  Flew over the Cuckoos Nest, and it’s failure to cure Ernest Hemingway, it remains in use today. Significant improvements in the technique of ECT have been made since those early days, including the use of synthetic muscle relaxants, the anesthesia of patients with short-acting agents, pre-oxygenation of the brain,and  the use of EEG seizure monitoring. I administered this procedure myself during training and it is a fairly benign process with a 90% success fast onset rate for severe depression.  The mortality rate is an acceptable 1:10,000. Oral antidepressants work about 70% of the time but not very expeditiously.

The good thing about these shock therapies is that they work rapidly. Such is the case with the venomous sea snail Conus Geographus that releases insulin into the surrounding water. The insulin forms part of a poison mixture evocatively known as “nirvana cabal”. It allows the snail to disable entire schools of swimming fish by sending them into “hypoglycemic shock”, a condition brought on by plummeting blood sugar levels. Sakel brought his patients around with glucose but I have no idea how my friend is going to drink orange juice through a diving mask.
Perhaps he should collect rare coins.

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