134 THE DISEASES OF THE THYROID GLAND 



uterus and ovaries are highly hypoplastic and the breasts fail to develop. 

 In males the penis is very small, the testicles do not descend at all or descend 

 very late, and in many cases are essentially smaller than in the normal indi- 

 vidual. The pubic and axillary hair does not develop. With the failure of 

 sexual maturity in boys, there occurs also the failure of the change of voice. 



The hematopoietic system also suffers in development. The hemoglobin 

 contents is for the most part much reduced, more than the number of erythro- 

 cytes. This behavior was very well illustrated in the three cases described 

 although all three had been treated for a long time with thyroid tablets. For 

 the most part the number of leucocytes is increased. The differential count 

 of these shows an enormous reduction in the polymorphonuclear neutrophiles 

 and a corresponding increase of the mononuclear cells, even when we con- 

 sider that in children the number of neutrophile cells is smaller than in adults. 

 The leucocytic picture shows the type of earlier stages of development 

 (Meunacher). Among the mononuclear cells are found a great number of 

 granular cells. Also Turk's irritation forms are observed (Esser). 



The number of eosinophile cells is mostly very much increased. In my 

 three cases the percentage was 12 to 33. 



Thus the blood findings behave similarly to those of adult myxedemics, 

 only the deviations from the normal are more strongly expressed. Also the 

 pathologico-anatomical findings agree with this. While thyroidectomy in 

 adult animals does not lead to a distinct alteration of the bone marrow, there 

 has been observed by Kraus in young animals after thyroidectomy a lym- 

 phoid metamorphosis of the bone marrow; also Aschojf found in his case of 

 thyroaplasia a lymphoid metaplasia of the marrow of the femur. 



In sporadic cretinism, as in myxedema adultorum, there is found a para- 

 doxical action of the thyroid substance on the leucocytic formula. While 

 the administration of thyroid-gland substance in normal individuals increases 

 the count of mononuclears at the cost of polymorphonuclear neutrophiles, 

 we find in conditions of hypothyrosis under thyroid medication, together 

 with the increase in hemoglobin and the number of red cells, also an increase 

 in neutrophile cells, with a decrease in mononuclears. The abnormal forms 

 vanish from the blood and the leucocytic formula approaches its normal 

 constitution. In a case of juvenile myxedema (complicated with symptoms 

 of deficiency on the part of the other ductless gland), I observed that the 

 count of neutrophiles increased from 54 per cent, to 84 per cent, during a 

 two months' thyroid treatment. 



Esser saw in a myxedemic child the count of neutrophiles increase under 

 thyroid treatment from 19 per cent, to 41 per cent. ; later, intoxication symp- 

 toms developed and with these the count of neutrophiles again sank to 19 

 per cent. I offered in explanation of this case, that at first the thyroid 

 medication exercised its usual favorable influence on the blood picture of 

 hypothyrosis, but that later with the appearance of the intoxication symptom 

 it assumed the character of hyperthyrosis. 



