Y20 FRANCIS H. McCRUDDEN 



hypophysis, there is a case history of a man suffering from dyspituitrism, 

 showing marked muscular asthenia and low blood sugar (0.039 and 

 0.053 per cent in two determinations) (Cushing(&)) Forshbach and 

 Severin have reported nine such cases. Frank (a) observed in three atro- 

 phied babies 0.046, 0.040 and 0.050 per cent glucose respectively (0.10 

 to 0.11 per cent is the average figure for normal babies). 



This same association of profound asthenia and hypoglycemia has 

 been observed also after diphtheria poisoning (Rosenthal(fc)), phosphorus 

 poisoning (Frank(&)), hydrazin poisoning (Underhill(a)), thyroidec- 

 tomy and parathyroidectomy (Janney and Isaacsoii(a) (&)), in myxedema 

 (Gyelin), and in cretinism (Janney, Goodhart and Isaacson). 



After thyroparathyroidectomy (Underbill and Blatherwick), adrenal- 

 ectomy (Kahn and Starkenstein, Mackenzie, Porges(fr), Schwartz(a) (6)), 

 diphtheria toxemia (Rosenthal(6)), phosphorus poisoning (Frank and 

 Isaac(6), Kaufholz, Mohr(d), Porges(c)) and hydrazin poisoning (Un- 

 derbill^) (6)), the liver and muscles have been found to contain far less 

 than the normal quantity of glycogen. The low glycogen content of the 

 organs in these cases is due to an impairment in the glycogen forming 

 function. The carbohydrate ingested is not converted into glycogen 

 ( Forges (c) Frank and Isaac (6)). The liver of the adrenalectomized 

 animal, for example, does not store any glycogen even when glucose enough 

 is ingested to increase the blood sugar fivefold (Mackenzie). For a time 

 at least, the extra glucose simply remains in the blood (Janney and 

 Isaacson(a), Rosenthal(&), Underbill and Hogan, Frank and Isaac(&)) ; 

 what happens to it finally will be taken up later. 



It is evident that hypoglycemia is an indication of a profound defect 

 in the carbohydrate metabolism. And, considering the evidence connect- 

 ing glucose supply and muscular activity, it seems very probable that this 

 deficiency in available carbohydrate can be held responsible for the mus- 

 cular weakness in these conditions. This probability is much strength- 

 ened by the fact that in phosphorus poisoning and in diphtheria toxemia 

 there is a definite parallelism between the severity of the myasthenia and 

 the degree of hypoglycemia (Frank and Isaac (&), Rosenthal(&)) and 

 that in successfully treated Addison's disease a definite parallelism has 

 been observed between increase in strength and rise in blood sugar (Grote). 



Progressive Muscular Dystrophy 



Hypoglycemia and other evidence of abnormal carbohydrate metabo- 

 lism in progressive muscular dystrophy were first reported in 1916 by 

 McCrudden and Sargent (a), who observed that the muscular asthenia 

 in this condition runs parallel with the degree of hypoglycemia, and who 

 suggested that the disease is due to a disturbance of one or more of the 



