34 



GENERAL PART 



to make a few remarks on the influence that the ductless glandular system 

 exercises on the activity and development of the hematopoietic apparatus. 

 I should like to emphasize the fact that the thyroid secretion is necessary 

 for a normal development and activity of the hematopoietic apparatus. In 

 myxedema and still more in thyroid glandular insufficiency in youthful years 

 do disturbances in the formation of blood occur. Especially in infantile 

 myxedema does there come about a degree of anemia which is often not 

 inconsiderable, and a reduction of the erythrocyte count and the amount of 

 hemoglobin ; the involution of the lymphatic apparatus is insufficient ; in the 

 blood picture the neutrophilic leucocytes retrogress, and the mononuclear 

 and eosinophilic predominate. On the administration of thyroid extract 

 these disturbances disappear wholly or at least in great part. Similar, but 

 less pronounced, manifestations occur in other ductless glandular diseases 

 due to absence of secretion, as, for example, hypophysial dystrophy and 

 eunuchoidisin. The production of neutrophilic granulocytes hence seems to 

 require a furthering influence on the part of the thyroid gland and chrom- 

 affin tissue. From this fact are elicited relations of the ductless glands to the 

 so-called status lymphaticus. The significance of a hypoplasia of the 

 chromaffin system for this condition has been mentioned, especially by 

 Wiedel, Hedinger, and Eppinger and Hess. 



A noteworthy influence on the hematopoietic apparatus is exercised by 

 the increase of function of the thyroid gland. The finding of Kocher, that 

 the count of mononuclear cells in the blood considerably predominates, is 

 one of the most constant features of Basedow's disease. In addition to this 

 relative and (to a great extent) absolute increase of the mononuclears (and 

 sometimes of the eosinophiles), there is found, just as frequently, an absolute 

 diminution of the neutrophilic cells in the circulating blood. Often the 

 relative increase of the former is only the sequel of the absolute diminution of 

 the latter. It seems to me that in this connection should be mentioned the 

 fact that Bertelli and / after the administration of thyroidin to dogs found an 

 accumulation of neutrophilic cells in the blood of the liver. It seems there- 

 fore that thyroidin influences the distribution of blood in the vascular tree. 

 The alterations in the blood picture in Basedow's disease are therefore not 

 analogous throughout to those of myxedema; which is best explained by 

 the fact that on administration of thyroidin in myxedema the blood picture 

 approaches the normal, while in Basedow's disease it diverges from the 

 normal (Falta, Newburgh, and Nobel). We are dealing in the first case with 

 symptoms of absence, in the latter case with irritative manifestations. 



Same as has already been described, sympathicotropic and autonomo- 

 tropic substances influence the blood picture and the distribution of the 

 leucocytes in the vascular tree in a definite way, we can comprehend the 

 fact that symptoms of irritation in ductless glandular affections and in part 

 also the symptoms of absence are the result of an altered condition of ex- 

 citability in the vegetative nervous system. 



