BASEDOW S DISEASE 73 



In the second period 0.52 3rd day of the purin free diet. 



0.78 20 gm. sodium nucleinate (the greater part vomited). 



0-53 



0.75 200 gm. meat. 



0.6 1 



In this case we find therefore, in spite of very evident Basedow's symp- 

 toms, the blood picture at first normal, and then showing the typical 

 changes. I observed a short time ago a still more striking case. Here in 

 the beginning all the typical signs of a Basedow's disease were present. 

 The tremor was especially strong. The blood examination showed 8800 

 leucocytes with 65.8 per cent, polymorphonuclear neutrophiles, 2.2 per 

 cent, eosinophiles, 0.5 per cent, mast-cells, 5.5 per cent, transitionals, and 

 26 per cent, lymphocytes. After two weeks another blood examination 

 was made. This showed 53 per cent, polymorphonuclear neutrophiles, 7 

 per cent, eosinophiles, 0.5 per cent, mast cells, 45.5 per cent, lymphocytes. 

 The clinical picture was not essentially changed otherwise. It is worthy 

 of mention that for some days before the second count much meat had 

 been ingested. 



For the interpretation of the blood alterations in Basedow's disease it is 

 important to note that the mononucleosis increases on the ingestion of thy- 

 roid-gland tablets, while, as we shall see later, it decreases in conditions 

 of athyrosis, the blood picture approaching the normal. This relationship 

 was first described by Falta, Newburgh, and Nobel; and lately Th. Kocher 

 apparently without knowing our work, has written about the practical 

 significance of this finding. 



Intercurrent febrile diseases bring about the transitory disappearance of 

 the mononucleosis (Roth). I have seen a case of Basedow's disease, in which 

 a croupous pneumonia developed. Before the development of the pneu- 

 monia, there were 6200 leucocytes with 46 per cent, neutrophilic cells; 

 at the height of the pneumonia there were 17,100 leucocytes with 87 per 

 cent, neutrophiles. It is also known that a transitory neutrophilic hyper- 

 leucocytosis occurs in Basedow's patients a short time after the removal 

 of the struma. 



The mononucleosis is readily produced experimentally by feeding with 

 thyroid-gland tablets. Berlelli, Schweeger, and / have regarded it as the 

 expression of an excitation of the autonomous system. Eppinger and Hess 

 have explained in like manner the hypereosinophilia sometimes observed in 

 Basedow's disease. We must consider in this connection not only the 

 absolute or often only relative increase in the mononuclear cells, but must 

 regard as of value the relative and always absolute diminution in the neutro- 

 philic cells in the peripheral vessels. In the cases with leucopenia the num- 

 ber of mononuclear cells is not increased absolutely, in spite of the marked 

 relative increase; here the alteration of the leucocyte formula is brought 

 about exclusively through the marked deficiency in neutrophilic cells. In 



