METABOLISM IN NEUROMUSCULAR DISEASES ?27 



for examination. Analysis showed 0.064 per cent glucose, a fall of 0.009 

 per cent from the previous day. The result is at least strongly suggestive, 

 though not alone to be taken as definite indication of any disturbance in 

 giycogenolysis. 



Fatty Infiltration. A sort of antagonism between fat storage and 

 carbohydrate storage has long been recognized (Rosenfeld(a) ). When the 

 power to store glycogen becomes impaired, fat is stored instead. In dia- 

 betes, for example, the capacity of the liver to store glycogen becomes 

 impaired and fat is .stored instead. In a starving (Jog, the amount of fat 

 in the liver may rise to ten per cent. If carbohydrate, or protein which 

 yields carbohydrate, be administered, the liver fat falls to about six per 

 cent. If fat be given to a starving dog, the fat content of the liver may 

 rise to 25 per cent; but if carbohydrate be ingested at the same time, the 

 liver fat does not increase in this way (Rosenfeld(&)). 



The same thing appears to take place in all forms of experimental im- 

 pairment of the glycogen forming function. The normal fat content of 

 the human liver is a little over three per cent (Heffter, von Stark). After 

 phosphorus poisoning it may run up to 25 or 30 per cent or even more 

 (Frank arid Isaac(fr), Heffter, von Hoselin (von Stark). There is also 

 an increase in the fat content of the muscles (Krehl(a) and Leick 

 and Winkler). Wells (c) observed an increased fat content of the 

 liver in cases of hydrazin poisoning. In one of his experiments 

 on 'dogs, Forges (c) noted that, during the operation of removing the 

 adrenals the liver was normal; at necropsy, shortly afterward, it was 

 observed that the liver had undergone fatty transformation. In other 

 words, fat was stored instead of glycogen. In cases of hypopituitrism, 

 another condition accompanied by hypoglycemia and muscular weakness, 

 Gushing (&) has noted the occurrence of fatty transformation of the liver. 



Exactly what happens in these cases is not entirely clear ; but the delay 

 in the disappearance of glucose from the blood after it has been admin- 

 istered (Frank and Isaac(6), Janney and Isaacson(a), Rosenthal(6), 

 Underbill and Hogan) and the increase in the fat content of the blood 

 at the same time (Underbill and Bauman(6)) strongly suggest that the 

 glucose is transformed, not into glycogen, but into fat instead. And this 

 hypothesis receives further support from the fact that the respiratory 

 quotient rises at this time. The basal metabolism is also below the normal 

 (Brock and Kay). 



In view of the foregoing facts indicating a relationship between hypo- 

 glycemia, impaired glycogenesis, and fatty infiltration, the deposition of 

 fat in the muscles in cases of muscular dystrophy which is responsible for 

 the pseudomuscular hypertrophy can, with a strong probability of cor- 

 rectness, be attributed to an attempt on the part of the muscles to store fat 

 instead of glycogen, a process quite in analogy with the process that takes 



