414 NELSOJST W. JANNEY 



The Blood in Hypothyroidism. The first important studies were 

 carried out bv Kocher (/) and his pupils in myxedema cases. There is 

 regularly a reduction of the red cells, which is usually of the nature of a 

 mild secondary anemia. The hemoglobin is reduced proportionately. A 

 normal red cell enumeration, which may rarely be found, has been ac- 

 counted for by a temporarily increased density, i.e., specific gravity of the 

 blood (Schneider). The erythrocytes may be found enlarged, and nu- 

 cleated cells may appear. Falta reports the presence of myeloblasts. Blood 

 platelets of extraordinary size have been noted. The oxyhemoglobin con- 

 tent is reduced and carbon dioxid increased. The dry residue is decreased. 

 (For literature see Falta's monograph.) 



A leucopenia was found in all but 26 cases of 155 cases of myxedema 

 reported by Kocher, the white cell count lying between 3000 and 6000 per 

 cm. as a rule. This was regarded together with a less degree of lympho- 

 cytosis as distinguishing obscure myxedema from thyrotoxicosis, This 

 means of differentiation is regarded as valueless by McCarrison, who 

 contends that there is no blood picture typical of either thyrotoxicosis or 

 hypothyroidism. It. is, however, certain that a marked relative reduction 

 of the polymorphonuclear cells even to 30 to 40 per cent and an increase of 

 the small lymphocytes is certainly the rule in severe cases of hypothyroid- 

 ism (Fonio). Concerning the eosinophiles and large mononuclears, a 

 difference of opinion may be noted in the literature. By some writers the 

 eosinophiles are reported increased, not by others who found mononucleosis 

 to he more constant (Falta, Newburgh and Nobel, etc.). The latter con- 

 dition seems of particular significance. The average leucocytic formula 

 of a series of cases recently studied by the writer and Henderson is poly- 

 morphonuclear leucocytes 51.1 per cent, lymphocytes 36.1 per cent, mono- 

 nuclear leucocytes 3.53 per cent, eosinophiles 0.99 per cent, other elements 

 1.09 per cent. This blood picture, which may likewise be found in thyro- 

 toxicosis and diseases of other endocrin glands, is regarded as a recession 

 to a fetal type due to degenerative changes in the hernatopoietic organs. It 

 is a striking fact that proper thyroid administration causes the leucocytic 

 formula to revert toward the normal. Interruption of treatment causes a 

 return to the former condition. Increased toxicity of the blood serum has 

 also heen shown experimentally by Gley. Decreased power to resist bac- 

 terial toxins has heen reported by Fassin. The oxyhemoglobin has been 

 found reduced by Massin which corresponds to ITorsley's observations of 

 the venous appearance of the blood. 



The coagulability of the blood is decreased rather constantly (Kocher 

 and Kottnian ) and should be ascertained in dubious cases. There may 

 bo a tendency to epistaxis and uterine bleeding. Hemorrhagic tendencies 

 in hypothyroid cases have been reported by Ilertoghe and others. A very 

 interesting case has recently been described with literature by L. P. Bot- 

 taro and J. ( 1 . Mnssio-Fonrnier. A iirl of eleven years suffered from 



