722 FRANCIS H. McCRUDDEN 



cular wasting could lead to hypoglycemia, then we should find low blood 

 sugar in certain cases of rapidly progressing chronic arthritis, in which 

 extensive and rapid muscular wasting is a prominent symptom. Table 4 

 shows the blood sugar in seven cases of generalized muscular atrophy, ac- 

 companying chronic arthritis (the first two reported by McCrudden and 

 Sargent (a), the last five by Janney, Goodhart and Isaacson). 



TABLE 4 



SHOWING NORMAL BLOOD SUGAR IN MUSCULAR ATROPHY SECONDARY TO CHRONIC 



ARTHRITIS 



An observation made in one of the cases reported by McCrudder and 

 Sargent (a) (6) that emphasizes strongly the relationship of myasthenia to 

 the low blood sugar, is the parallelism between increase in muscular 

 strength and rise in blood sugar. When first seen the patient was very 

 weak, and for a long time had been able to walk, even with the aid of a 

 walking stick, only clumsily and with difficulty, for a short distance. Ad- 

 ministration of adrenalin and pituitrin, suggested by Dr. Spear of 

 Boston as a means of mobilizing glycogen, was followed by rapid and 

 marked improvement. He was eventually able, without the use of a cane, 

 to climb the highest hill in Boston, on "a winter day when the ground was in 

 such bad condition, from rough ice and snow, that walking was exception- 

 ally difficult. The patient was last seen about three and one-half years 

 after improvement began, the improvement appeared to be permanent. 



The figures for blood sugar follow : 



TABLE 5 



SHOWING PARALLELISM BETWEEN IMPROVEMENT IN STRENGTH AND RISE IN BLOOD 

 SUGAR IN CASE OF PROGRESSIVE MUSCULAR DYSTROPHY 



Oct. 27, 1915 0.068 



Nov. 5, 1915 0.060 



Treatment begun 



Nov. 16, 1915 ( I 0.074 



Nov. 23, 1915 bteady 0091 



Nov. 30, 1915 J im P r <>. vement I 0.081 



Feb. 21, 1916 ln ., 0.095 



June 20, 1916 8trength " J 0.110 



March 7, 1917 0.103 



At this point it may be well to advise caution in administering glucose 

 intravenously in these cases. Underbill (a) administered glucose intra- . 



