260 A. I. RIXGER AXD EMIL J. BAUMAXN 



mate to state that at least 200 publications have appeared on this sub- 

 ject." Every conceivable theoretical possibility finds its defense and ex- 

 perimental support in one place and is met by just as convincing objection 

 in another place. 



That we are dealing with an internal secretion there is absolutely no 

 question. That it is the pancreas that is supplying that internal secre- 

 tion seems proved beyond doubt but its modus operand i and locus nasceiuli 

 is as problematical to-day as heretofore. To the Islands of Langerhans 

 we are now inclined to attribute the production of the "antidiabetic" 

 hormones, but there is still room for direct and crucial experiments to 

 prove this hypothesis. 



Influence of the Thyroid Gands. The thyroid influences the carbo- 

 hydrate metabolism to a very considerable extent. Because it seems to 

 have a stimulating effect on the entire plane of metabolism it undoubtedly 

 affects the velocity of carbohydrate oxidation at the same time. Speci- 

 fically it affects the carbohydrate metabolism in such a way that whenever 

 there is a hyperf unction there is a tendency to lowered carbohydrate toler- 

 ance, i. e., hyperglucemia and glucosuria after the ingestion of 100 grams 

 of glucose, and when there is a hypof unction, as in the case of cretinism and 

 myxedema, we usually find a normal or increased tolerance for carbo- 

 hydrates. (Janney and Isaacson, 1918.) 



A great deal of confusion exists in the literature on the subject, prob- 

 ably because of the studies published on clinical cases that are not clearly 

 defined. Because of the,present tendency to attribute a great many cases 

 of nervous disturbances to Lyporthyroidism, one will naturally get a good 

 many negative results. But w T hen one examines the records of authentic 

 cases of hyperthyroidism, one seldom fails to find evidences of a very 

 marked lowering of the carbohydrate tolerance. Of interest in this con- 

 nection is the observation of Jones (1893) and of Fr. Miiller (1906(<r)), 

 both of whom reported the development of glucosuria in patients who were 

 taking thyroid gland in excessive amounts. Von Notthaft (1898) also 

 reports a case of true exophthalmic goiter complicated by glucosuria de- 

 veloping in an obese individual who had taken 1000 thyroid tablets in the 

 course of five weeks. 



There is no interference with carbohydrate oxidation in case of hyper- 

 thyroidism. The respiratory quotient after the ingestion of 100 grams of 

 glucose, in the observations of DuBois ( 1916 (&)), was 0.94 and 0.98, in the 

 latter case showing that 89 per cent of the calories was derived from the 

 glucose oxidation. On the other hand, the basal metabolism of the pa- 

 tient 17 hours after the last meal shows a respiratory quotient of 0.77, 



"Excellent reviews of the literature up to 190S are given by 5. Rosenberg: "Jnnere 

 Sekretion, Pankreas urul Glykolyse," in Oppenheimer's Handbuch dcr Jiiochemie des 

 Menschen mid der Tiere. Vol. Ill, part I. pp. 245-270. And up to 1033 by F. M. Allen 

 in Studies concerning Glycosuria and Diabetes, chapter XXI. pp. 898-985. 



