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The purpose of this report is to record a series of cases of exophthalmic goitre studied intensively by the supravital technique of blood examination. This method was chosen as being particularly suited to the problem since it affords a clear differentiation of the large lymphocyte, monocyte and transitional polymorphonuclear cells, a distinction which is not always possible in the ordinary type of fixed smear. HISTORICAL While Ciuffini (1) described relative lymphocytosis in exophthalmic goitre in 1904, this aspect of the disease did not attract universal attention until the publications of L. Caro (2) (3). In the year 1907 the latter author described a case of fatal exophthalmic goitre with such atypical findings in the blood that he thought he was dealing with an associated pseudoleukemia. Later (1908) he collected a series of cases showing similar blood pictures. Caro was furthermore able to produce the changes in the blood of normal individuals by the oral administration of thyroid gland. He showed that patients with non-toxic varieties of goitre did not have any alteration in their blood picture. The studies of Kocher (4) in 1908 received the attention of the entire medical profession. He described a triad of blood findings in Basedow's disease which he thought could be used in the early diagnosis of the malady. This triad consisted of leukopenia, relative hypopolynucleosis and relative lymphocytosis. It has come to bear his name as the " Kocher blood picture." Crotti (5) was able to confirm the observations of Kocher and stated that the blood findings were helpful in diagnosing the disease and in estimating its severity. Crotti (5) observed cases during the postoperative period before the introduction of iodine in the preoperative treatment. We quote him directly as follows: "The same day of the operation the lymphocytes diminish materially while the polynuclears increase; on the following days, however, the blood formula returns to its previous pathological state, and only then improves gradually in direct proportion with the disease and usually becomes normal in the cured cases." DeQuervain (6) stated that the above changes were not limited to exoph-thalmic goitre, for they occurred in other types of thyroid dyscrasia. Muller (7), Bauer (8) and Lampe (9) were of the same opinion. Probably the most extensive study of the subject was that of W. A. Plummer (10) in 1919. He examined the blood of 578 cases of hyperthyroidism and recorded an average leukocyte count …

THE BLOOD PICTURE IN EXOPHTHALMIC GOITRE AND ITS CHANGES RESULTING FROM IODINE AND OPERATION. A STUDY BY MEANS OF THE SUPRAVITAL TECHNIQUE