Insulin Administration 



431 



In sharp contrast to the above findings during the convulsions 

 of insulin shock, a very marked increase in the serum phosphate 

 and serum potassium has been found during strychnine convul- 

 sions in rabbits, in which condition, as is well known, an extreme 

 destruction of muscle glycogen occurs. 



In seeking an explanation of the above phenomena, attention 

 is drawn to the recent work of Embden, Meyerhof, A. V. Hill, 

 and others, which indicates that a hexose diphosphate is an inter- 

 mediary between glycogen and lactic acid in the contractile 

 process in the muscles. It is suggested that an analogous phos- 

 phate compound is formed during the process of storage of gly- 

 cogen and that insulin causes or accelerates its synthesis. This 

 would account for the disappearance of phosphate into the tis- 

 sues during the period in which insulin is acting, and the sub- 

 sequent increased excretion of phosphate may be due to the 

 further conversion into glycogen of the hexose portion of the 

 hexose diphosphate, thus leaving the excess of phosphate avail- 

 able for excretion. The massive, rapid breaking down of the 

 phosphate compound during the tetanic convulsions of strych- 

 nine, would further account for the appearance of inorganic 

 phosphate (as well as lactic acid) in the blood stream, as has 

 actually here been shown to occur. The shift in concentration 

 of the potassium indicates the formation of a monopotassium 

 salt. 



214 (2174) 



An electrocardiographic sign in pericardial effusion. 



By B. S. OPPENHEIMER and HUBERT MANN. 



[From the Medical Department, Montefiore Hospital, New York 



City.] 



The electrocardiogram as ordinarily taken is a record of the 

 differences of potential occurring between various parts of the 

 body remote from the heart. While these differences of poten- 

 tial can be shown to be due to a primary electrical effect in the 



