ADDENDUM 147 



the two forms of anesthesia summate in some other way is of theoretical im- 

 portance ; practically, the good results speak for themselves, and are attested 

 to by Frazier and Mutter. The method is attended with a number of refine- 

 ments of technique for the consideration of which the reader is referred to 

 Crile's work. One of the important factors is a sort of psychic treatment, 

 consisting in the fact that the .patient is gradually habituated on successive 

 days to the method of general anesthesia, while under the impression that 

 he is receiving treatments. As has already been stated at another place, 

 Crile's theory is based on observations on 40,000 nerve cells, and forms an 

 interesting explanation for the r61e of the central nervous system in the 

 etiology of Basedow's disease. 



The effect of thyroid secretion on the central nervous system, the close 

 connection of the central nervous system with the thyroid is instanced in the 

 association of epilepsy with thyroid disease, especially exophthalmic goiter. 

 This association which is acknowledged cursorily by Kocher and Gushing was 

 pointed out by the translator some time ago. It is interesting that a short 

 time after the translator presented his cases, through courtesy of Potts he 

 presented the history of an adult female who developed epileptiform convul- 

 sion for the first time after the use of double the prescribed doses of thyroid 

 extract. It is probable that in this case, and in some of the cases previously 

 reported by the translator, the thyroid-gland substance acted as a toxic 

 agent on a central nervous system already predisposed to the occurrence of 

 epilepsy. It is interesting, however, that the thyroid extract is one of the 

 metabolic products that acts in this way. 



With regard to the laboratory symptomatology of Basedow's disease, 

 Kocher has corroborated his conclusions as to the blood picture in Basedow's 

 disease by over 670. cases that have been operated on. He regards the blood 

 examination as of the greatest diagnostic importance in light and obscure 

 cases of Basedow's and myxedema. In 155 cases of myxedema there were 

 only twenty-six that did not show a leucopenia. The degree of absolute 

 leucopenia is more considerable than in Basedow's disease, lying between 3000 

 and 6000. Lymphocytosis lies between 30-40 per cent, less than in Base- 

 dow's disease. The mast-cells are 0.2-0.4 per cent. In myxedema the 

 coagulation time is decreased, to as low as six minutes. This hastening of 

 coagulation is very constant. The blood picture approaches the normal 

 with favorable therapeutic procedures. 



Cases of diffuse colloid goiter approach the type of blood picture of myxe- 

 dema. Nodular goiters show, as a rule, a normal blood picture, or, occasion- 

 ally that of hyperthyrosis. 



This blood picture has been much discussed, and is worthy of even more 

 close study than it has received, especially in view of the more recent studies 

 of the pathology of the thyroid gland in goiter by Wilson and by Plummer, 

 stated below. 



