METABOLISM IN NEUROMUSCULAR DISEASES 729 



when the liver is undamaged, administration of epinephrin (or other en- 

 docrin principle) decreases the glycogen of the liver (Agadschanianz; 

 Doyon and Kareff(a), Gatin-Gruzewska), and thereby increases the 

 glucose of the blood (Blum(a) (6). Zuelzer(c) and many others since 

 then). But when the liver is damaged, as in the case of phosphorus 

 poisoning or hydrazin poisoning, adrenalin does not increase blood sugar, 

 at any rate, not to the same extent (Falta and Priestley, Frank and Isaac 

 (a), Herter and Richards, Michaud, Pollack (d), Ringer (a), Velicke). 

 During the first twenty-four hours after phosphorus poisoning, while the 

 liver is still intact, epinephrin increases the blood "sugar; after the first 

 twenty-four hours the glycogenesis-glycogenolysis mechanism of the liver 

 is so badly damaged that glucose can no longer be derived from it under 

 the influence of epinephrin (Frank and Isaac (6)). 



In the case of progressive muscular dystrophy, the prompt and marked 

 rise in the blood sugar, and improvement in strength following adminis- 

 tration of epinephrin and pituitrin indicates that the glycogenesis-glyco- 

 genolysis mechanism of the liver is not directly damaged. The hypo- 

 glycemia, the impairment in the power to store glycogen, the fatty infil- 

 tration, the creatinuria and the profound myasthenia, all symptoms which 

 are characteristic of endocrin disease, strongly suggest that progressive 

 muscular dystrophy is an endocrin disease. The delayed blood sugar curve 

 (the delay in disappearance of sugar from the blood after glucose admin- 

 istration) is precisely similar to the delayed blood sugar curve in thyroid- 

 ectomized dogs (Janney and Isaacson(fr) ). 



Clinical evidence, suggesting an endocrin origin for muscular dys- 

 trophy, is seen in the trophic changes in the bones, tendons, and nails, in 

 the dryness and abnormal pigmentation of the skin, hypertrichosis, and 

 brittleness of the hair; in the distribution of the subcutaneous fat; and 

 in the frequent occurrence of the disease in association with dwarfism, 

 exophthalmic goiter, acromegaly, and underdevelopment of the genitalia 

 (Janney, Goodhart and Isaacson). 



It is probable that progressive muscular dystrophy is not a definite dis- 

 ease of one of the ductless glands, but rather a symptom complex that may 

 result from disfunction of any one of several glands. A number of 

 cases of muscular dystrophy have been reported in patients with hyper- 

 thyroidism (Boveri, von Werdt). Several cases with bony changes similar 

 to acromegaly have been reported, pointing to pituitary involvement 

 (Bregman, Eulenberg; Janney, Goodhart and Isaacson). The case re- 

 ported by McCrudden and Sargent(a), showing such marked improvement 

 under adrenalin and pituitary therapy, seems to have been one in which 

 either the adrenals or the pituitary gland were involved. Several cases 

 have been reported in which there appears to have been pineal involve- 

 ment (Janney, Goodhart and Isaacson, Timme). 



It is alleged that epinephrin decreases, and the internal secretion 



