THE THYEOID GLAND AND ITS DISEASES 493 



agrees with the results of others. Hyperglycemia is considered to be 

 present when the blood sugar content rises above 0.10 per cent. Myers 

 and Bailey simplified the method of Lewis and Benedict. An initial blood 

 dilution of 1 to 5 instead of 1 to 12.5 is used and in this way a suffi- 

 ciently low concentration is obtained to obviate the necessity for evapo- 

 ration in the development of the color. For this determination the 

 Hellige colorimeter has been found especially satisfactory. In all other 

 essential respects the method is that of Lewis and Benedict. By the use 

 of these colorimetric methods the determination of blood sugar has been 

 placed upon a practical clinical basis, and as a result it has now been 

 abundantly shown that in hyperthyroidism there is a diminished tol- 

 erance of carbohydrates with alimentary hyperglycemia followed by gly- 

 cosuria whenever the hyperglycemia exceeds the renal glucose threshold 

 of the individual case (McCaskey). In every case of hyperthyroidism 

 which McCaskey studied, after the ingestion of 100 gms. of glucose the 

 blood sugar content was increased within two hours from 50 to 200 

 per cent. In TO per cent of 31 cases the maximal rise occurred at the 

 end of the first hour with a more or less sharp decline at the end of the 

 second hour, proving that the crest had been reached and passed. The 

 very few cases in which hyperglycemia is highest at the second hour he 

 thinks are explained by gastric hypomotility and slow intestinal ab- 

 sorption. 



Denis, Aub and Minot carried out a series of experiments dealing 

 with the effect produced by carbohydrate ingestion upon persons suffering 

 from hyperthyroidism. Coincident with these experiments they made 

 observations on the gaseous metabolism of these patients with the idea 

 of establishing if possible some relation between the increase in metabolism 

 found in this condition and the effects produced on the blood sugar level 

 by the ingestion of carbohydrate. The blood sugar determinations were 

 made by the method of Lewis and Benedict as simplified by Myers and 

 Bailey, 2.4 c.c. of blood being used for each determination. Qualitative 

 and quantitative determinations of sugar in urine were made by Bene- 

 dict's methods. More recently another method, also colorimetric, for the 

 determination of sugar in small quantities of blood has been devised by 

 Folin. By some this method is felt to be simpler and to afford less 

 chance for error than the Myers and Bailey method. 



Method of Procedure. Between 7 and 8 A.M. the patient who has 

 received no food since 5 o'clock on the previous afternoon is given 100 

 gms. of glucose, 50 gms. of bread and 20 gms. of butter. Just previous 

 to this meal a sample of urine is secured and five cubic centimeters of 

 blood are taken by venepuncture. Samples of blood and urine are then 

 obtained at hourly intervals, from three to five samples of blood being 

 taken from each patient. The method used for determination of the 

 metabolism is that described by Benedict (1918 



