728 FRANCIS H. McCRUDDEN 



place in all other conditions in which there is a similar impairment of the 

 carbohydrate metabolism. 



In connection with the foregoing, it seems worth while suggesting 

 that some cases of heart disease, especially the so-called "fatty degenera- 

 tion" of the heart, may possibly be the result of an impairment, possibly 

 local, of the carbohydrate metabolism, a condition that we might call 

 pseudohypertrophic cardiodystrophy. This is certainly the case for the 

 fatty degeneration of the heart occurring in severe diphtheria, and in cer- 

 tain endocrin diseases. These conditions lead to hypoglycemia and im- 

 paired glycogenesis ; the organs, including the heart, store fat instead of 

 glycogen. Only one blood analysis, in the case of a fatty heart, has been 

 reported (McCrudden(^)), and that was very low, 0.0662 per cent. In 

 this connection, the heart stimulating properties of adrenalin (a substance 

 that increases the rate of glucose formation from glycogen) may be men- 

 tioned. Biidinger(a) (&) has recently suggested a similar hypothesis, 

 namely, that certain cases of heart failure are the result of either an insuffi- 

 cient supply of glucose in the blood, or an inability to elaborate and store 

 glycogen. He obtained very good results in such cases from injections of 

 glucose solution. Pfalz, who followed out Biidinger's treatment in a num- 

 ber of cases, had very good results especially in cases of coronary sclerosis 

 with angina pectoris. 4 



In this connection, it may not be out of place to suggest that just as 

 the glucoside phlorizin has a profound local influence on the carbohydrate 

 metabolism of the kidney, so may the actively stimulating digitalis gluco- 

 sides have an effect on the carbohydrate metabolism of the heart. 



Progressive Muscular Dystrophy as an Endocrin 



Disease 



All forms of experimental interference with the glycogenesis-glyco- 

 genolysis mechanism appear to act either on the liver (and possibly on the 

 muscles and other organs which store glycogen) directly, or on the endo- 

 crin glands which control the mechanism in the liver and other organs. 

 Phosphorus poisoning and hydrazin poisoning, for example, cause direct 

 liver damage. In cases of diphtheria toxemia, Addison's disease, and 

 other conditions in which hypoglycemia follows damage or removal of 

 the adrenals, thyroid, or hypophysis, the resulting effect on the glyco- 

 genesis-glycogenolysis mechanism is indirect; it is the consequence of an 

 insufficient supply of the internal secretions which control the process. 



It is possible to determine which of the two, liver or endocrin organs, 

 is at fault, by the effect of epinephrin administration. Normally, or 



*As this book goes to press I find two cases of progressive muscular dystrophy 

 with post-mortem findings reported by Goodhart and Globus in which changes in the 

 heart muscle were found similar to those found in the skeletal muscles. 



