A study was undertaken of blood and urine alcohol levels in 44 cases where the bodies had been immersed in water, following accidents, for at least one day after death. In no case was there any ante-mortem evidence of ingested alcohol. In 15 cases there was a raised urine alcohol. The average urine-to-blood alcohol ratio in these cases was 0.56:1. This is dramatically less that that seen after ingestion. It is suggested that the alcohol, following its initial post-mortem production in the abdomen, enters the urine by diffusion from surrounding tissues. The presence of alcohol in the urine from bodies that have not been recovered and examined until several days after death cannot always be taken to indicate ante-mortem ingestion. Urine-to-blood alcohol ratios of less than 1:1 are strongly suggestive of post-mortem production.

Objective: To study the comparative importance of environment and genes in the development of islet cell autoimmunity associated with insulin dependent diabetes mellitus. Design: Population based study of diabetic twins. Setting: Danish population. Subjects: 18 monozygotic and 36 dizygotic twin pairs with one or both partners having insulin dependent diabetes. Main outcome measures: Presence of islet cell antibodies, insulin autoantibodies, and autoantibodies to glutamic acid decarboxylase (GAD65) in serum samples from twin pairs 10 years (range 0-30 years) and 9.5 years (2-30 years) after onset of disease. Results: In those with diabetes the prevalence of islet cell antibodies, insulin autoantibodies, and autoantibodies to glutamic acid decarboxylase in the 26 monozygotic twins was 38%, 85%, and 92%, respectively, and in the dizygotic twins was 57%, 70%, and 57%, respectively. In those without diabetes the proportions were 20%, 50%, and 40% in the 10 monozygotic twins and 26%, 49%, and 40% in the 35 dizygotic twins. Conclusion: There is no difference between the prevalence of islet cell autoantibodies in dizygotic and monozygotic twins without diabetes, suggesting that islet cell autoimmunity is environmentally rather than genetically determined. Furthermore, the prevalence of islet cell antibodies was higher in the non-diabetic twins than in other first degree relatives of patients with insulin dependent diabetes. This implies that the prenatal or early postnatal period during which twins are exposed to the same environment, in contrast with that experienced by first degree relatives, is of aetiological importance.

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