BASEDOW S DISEASE 71 



Rossin and Jellinek, very much reduced. The coagulation capacity of the 

 blood is in the most cases delayed. Kottmann and A . Lidsky found in thirty- 

 seven cases this delay in 78.3 per cent., a normal coagulation time in 5.4 per 

 cent., and an acceleration in 16.2 per cent. In the cases in which it was de- 

 layed, it approximated normal figures after operation. The delay also exists 

 in experimental hyperthyroidism (Kostlivy). These facts explain why in 

 operations on Basedow's patient the control of hemorrhage is often difficult. 

 According to Kottmann the serum of Basedow's patients works in a retarding 

 way on autolysis; also the freezing-point lies lower than under normal con- 

 ditions. Fr. Kraus and Friedenthal found that the blood-serum of Basedow's 

 patients acts in a mydriatic manner. A . Frdnkel found an increased action 

 on the wave-motions of the rabbit-uterus after the death of the animal. 

 These findings do not point absolutely to an existing adrenalinemia (O'Connor, 

 Falta, Fleming). Therefore the far-reaching conclusions that Kostlivy 

 has drawn from, these findings, as to the sympathcotonizing components 

 of the secretion of the thyroid gland, are purely hypothetical. Of greater 

 importance is the alteration in the leucocyte formula first described by 

 Th. Kocher. There exists at first a slight leucopenia and almost regularly, 

 even in the early stages, mononucleosis. The statements of Kocher have 

 been confirmed by numerous investigations (Caro, Ciuffini, Gordon and 

 v. Jagic, Roth, Buhler, Kappis, van Lier, Kostlivy, Turin and others). The 

 mononucleosis is also found in the formes frustes; but it is also common 

 in struma without Basedow's symptoms (Mutter, Ch. Kappis, van Lier, 

 and others). Cases of Basedow's with absent mononucleosis seems to belong 

 to the great exceptions (Kostlivy, Roth, Borchardt, the author). 



Observation VII. C. A., twenty-one years old, student. For about six weeks rapid 

 enlargement of the thyroid gland. Former circumference of the throat 39 cm., now 42 

 cm. Tachycardia, labile pulse, sweats, tremor, stools formerly sluggish, sluggish also at 

 present. Diffuse enlargement of the thyroid gland, consistence weak, pulsation of the 

 carotid. No eye symptoms. Apex-beat broadened and increased. In the urine traces 

 of sugar, after overloading (2 rolls, four pieces of sugar), 2 per cent. 



Blood examination: 



Leucocytes, 7000 of which: 



Neutrophiles, 68.6 per cent. 



Lymphocytes, 25.3 per cent. 



Mononuclears, 4.6 per cent. 



Eosinophiles, 1.5 per cent. 



After several months, essential improvement in all manifestations, high tolerance for 

 carbohydrates. 



It seems to me, however, that great caution is necessary in regarding the 

 blood picture in cases of Basedow's as normal, as the alterations of the 

 blood picture, like those of the other symptoms of Basedow's undergo great 

 changes. The following is a case in point: 



Observation VIII. Fl. R., woman, thirty-five years of age. First came under observa- 



