METABOLISM IN NEUROMUSCULAR DISEASES 719 



(McLean). The parathyroids, too, are in some way involved in the proc- 

 ess ; after removal of the parathyroids, adrenalin administration no longer 

 causes glycosuria (Mathews). These functions are indirectly under the 

 control of the nervous system, and damage to the floor of the fourth ven- 

 tricle, or severing the nervous connections of the adrenals or liver may 

 lead to abnormal alteration in the blood sugar concentration. The pan- 

 creas furnishes some product that enables the muscle to oxidize sugar; 

 and in pancreatic disease the absence of this substance may result in 

 hyperglycemia. The kidney regulates the upper Jimit of blood sugar 

 concentration, by eliminating glucose in the urine in diabetes, e. g. 

 when the concentration in the blood reaches a certain level. Under the 

 influence of phlorizin this threshold may be so greatly lowered as to result 

 in glycosuria without hyperglycemia. 



One symptom common to all conditions of hypoglycemia is great mus- 

 cular weakness. 



In three cases of Addison's disease a condition characterized by pro- 

 found prostration quantitative determination of the glucose content of 

 the blood by Forges (b) showed 0.052 per cent, 0.033 per cent, and 0.067 

 per cent all very low results. These findings have been confirmed in 

 other cases of Addison's disease (Bernstein (&), Shirokauer(o,), Holly and 

 Opperman(a)). 



Forges followed this point further in experiments on animals. He 

 removed the adrenals from several dogs and compared the glucose con- 

 tent before and after the operation. There was a decrease in the glucose 

 content of the blood in every case. His figures are shown in Table 2. 

 Mayer (c) and Bierry and Malloizel had previously reported a fall in the 

 blood sugar contents of cats after removal of the adrenals. 



This association of fall of blood sugar content, with muscular asthenia 

 and decrease in adrenalin, is quite in harmony with the fact previously ob- 

 served by Batteli and Boatti and by Schur and Wiesel(6) that the epi- 

 nephrin content of the blood of dogs decreases when these animals are 

 made to undergo exhausting work on a treadmill. 



An association between muscular asthenia and hypoglycemia has been 

 noted in dyspituitrism and in atrophied babies. In Gushing' s book on the 



