SPORADIC CRETINISM 



135 



In case N., Observation XV (sporadic cretinism), the neutrophilic count 

 rose from 42.5 per cent. (Nov. 9) to 61.5 per cent. (Jan. 18); in case A., Ob- 

 servation XVI, from 32.5 per cent. (Oct. 15) to 67.2 per cent. (Dec. 22), under 

 treatment with large doses of thyroidin. 



Summarizing these observations, it may be said that on the absence or 

 insufficient production of thyroid extract in the juvenile organism, the devel- 

 opment of the hematopoietic system is severely inhibited. Agreeing with 

 this is Diederle's observation that the disturbance in the growth of bone 

 does not lie in the marrow of the epiphysial cartilage alone, but also in the 

 bone marrow itself. Especially does the development of the neutrophilic 

 cells suffer damage. There exists a slight grade of status lymphaticus that 

 perhaps is in relationship with the faulty development of the chromaffin 

 tissue. 



The metabolism of sporadic cretinism has been carefully studied in the 

 excellent investigation of Magnus-Levy. I reproduce from the table of this 

 author the following figures: 



In the fully developed form, the fundamental exchange is therefore much 

 reduced. 



With this agrees the experiment of v. Bergmann. He investigated the met- 

 abolism of a one-year-old child, employing the Voit-Pettenkofer apparatus. 

 The child was put in equilibrium with a supply of calories that was far below 

 that needed for a healthy child of like weight. Concerning the albuminous 

 metabolism, I shall refer to the chapter on myxedema adultorum. The salt 

 metabolism in infantile myxedema is dealt with in investigations of Haugardy 

 and Langstein. These authors found that in their case the assimilation of 

 calcium amounted to about one-third of that of a normal child the same age. 

 In this the intensity of the inhibition of bone growth finds expression in a 

 pretty manner. 



As concerns the carbohydrate metabolism, I might mention that in the 

 three cases of sporadic cretinism that we investigated the assimilation limits 

 for carbohydrates lay rather high several weeks after the withdrawal of thyroid 

 medication. Also injection of adrenalin did not lend to glycosuria, while on 

 the contrary injection of adrenalin with simultaneous administration of sugar 

 always yielded strikingly high sugar percentages in the urine. Perhaps we 

 may seek the cause of this in the fact that in sporadic cretinism also the de- 



