492 EMIL GOETSCH 



secretion, a fact which has been shown to be true experimentally as well. 

 It has been ^hown further, that in Basedow's disease, with or without 

 spontaneous glycosuria, there is a lowered assimilation limit for carbohy- 

 drates (Kraus and Ludwig, Straus, Geyelin, O'Day ()). Alimentary gly- 

 cosuria was demonstrated by Goldschmidt in exophthalmic goiter and was 

 shown to occur also after thyroid administration. Wilder and Sansum 

 found that the intravenous glucose tolerance in health was approximately 

 0.8 gm. per kilogram of body weight per hour. No glycosuria occurred 

 with this dose but when 0.9 gm. were injected per kilogram per hour 

 sugar appeared in the urine. When comparing this normal tolerance with 

 the intravenous tolerance in five cases of exophthalmic goiter they found 

 that in all of the latter there was a reduction in tolerance varying from 

 0.5 gm. to 0.7 gm. per kilogram per hour according to the severity of 

 the cases, the more severe showing the lower degrees of tolerance. 



Carbohydrate Tolerance in Hypothyroidism. The converse of these 

 findings should occur whenever there is produced in an organism, either 

 experimentally or clinically, a diminution in the amount of thyroid secre- 

 tion. For example, it has been shown that after removal of the thyroid 

 gland there is a rise in the assimilation limit for dextrose (McCurdy). 

 A great many observations have been made in recent years to show that 

 in myxedema there is an increased sugar tolerance. Thus, for example, 

 Hirschl found that in an outspoken case of myxedema the administration 

 of from 200 to 500 grains of grape sugar did not produce alimentary 

 glycosuria. Other observers have noted (von Noorden (&)) that whereas 

 spontaneous glycosuria is not uncommon in exophthalmic goiter, it is so 

 rare as practically never to occur in myxedema. 



Blood Sugar in Hyperthyroidism. The occurrence of alimentary 

 hyperglycemia in hyperthyroidism has been known since the work of 

 Tachau (11)11) and Garrod (a) (1012). At that time, however, there was 

 a lack of uniformity in the methods of estimating blood sugar, and these 

 were at the same time too cumbersome for ordinary clinical use. It is 

 only in recent years that methods of determining blood sugar have 

 been sufficiently simplified and controlled to be of real clinical use. The 

 labors of Lewis and .Benedict (11)15) have placed this work on an entirely 

 different, clinically practical basis. They introduced a very simple and 

 ami rate- col ori metric method depending upon precipitation with picric 

 acid. Their method for the determination of sugar in the blood depends 

 upon a color obtained by heating a dextrose solution with picric acid and 

 sodium carbonate. In the case of the blood, protein is removed by pre- 

 cipitation with picric acid. This is then treated with picric acid and 

 sodium carbonate and evaporated. The residue is redissolved and the 

 color compared with the standard glucose-picric acid-sodium carbonate so- 

 lution or the. picramic acid standard. It was found that in normal per- 

 sons the average sugar content of the blood equals 0.10 per cent and this 



