552 



Messrs. Cramer and Krause. Carbohydrate [June 10, 



Falkenberg,* Eahel Hirsch,f and Underhill and SaikiJ found the tolerance for 

 carbohydrates to be diminished after thyroidectomy. In the experiments of 

 Falkenberg and of Hirseh the term "thyroidectomy" is used rather loosely, 

 and it is not clear whether the parathyroids were also removed or whether 

 all, or any of them, were left behind, while in Underbill's experiments 

 " both the thyroid and parathyroids were presumably completely removed." 

 Eppinger, Falta, and Eudinger,§ on the other hand, failed to find such a 

 condition after a thyroidectomy in which all four parathyroids were stated 

 to have been left intact. The subsequent work of Eppinger, Falta, and 

 Rudinger|| and of Underhill and HilditchIT showed that complete removal 

 of the parathyroids produces a transient but marked lowering of the tolerance 

 for carbohydrates. The effects of partial parathyroidectomy differ according 

 to the number of parathyroids removed. After the removal of one or two 

 "parathyroids the sugar-utilising power of the body is not decreased. 

 Additional removal of the thyroid does not affect this result according to 

 Underhill and Hilditch, who state that two parathyroids are sufficient to 

 maintain normal control of the nutritional processes of the body. When 

 three parathyroids are removed, the tolerance for carbohydrates is distinctly 

 lowered, whether the thyroid is left intact or removed with the parathyroids. 



The effects of thyroidectomy in the proper sense of the term are not so 

 clearly understood as those of parathyroidectomy. This is partly due to the 

 technical difficulty of removing the thyroid without at the same time 

 removing or at least injuring the two internal parathyroids. Eppinger, Falta, 

 -and Eiidinger state, in their second paper, that thyroidectomy in the proper 

 sense of the term, in which all four parathyroids are left intact, is followed by 

 an increased tolerance for glucose. But we have been unable to find either 

 in their first publication to which they refer, or in their subsecpuent paper, any 

 record which would clearly demonstrate an increased tolerance after removal 

 of the thyroid gland. McCurdy** observed an increased tolerance for carbo- 

 hydrates in three dogs from which the thyroid together with two parathyroids 

 had been removed. In one of these animals, however, the two remaining 

 parathyroids were unintentionally injured to such an extent that the dog 

 developed tetany and died. The fact that this animal too exhibited an increased 



* Falkenberg, lOte Congress f. innere Medizin, Wiesbaden, 1891, quoted from Eahel 

 Hirsch (see below). 



t Eahel Hirsch, ' Zeitschr. f. experimented Pathologie u. Therapie,' 1908, vol. 5, p. 233. 



X Underhill and Saiki, ' Journ. Biol. Chem.,' 1908, vol. 5, p. 225. 



§ Eppinger, Falta, and Eiidinger, ' Zeitschr. f. klin. Medizin,' 1908, vol. 66, p. 1. 



|| Ibid., 1909, vol. 67, p. 380. 



1" Underhill and Hilditch, ' Amer. Journ. Physiol.,' 1909, vol. 25, p. 66. 

 -** McCurdy, 'Journ. Exper. Med.,' 1909, vol. 11, p. 801. 



