The corpses of those dying thus are characterized by the enlarge ment of lymph-tiodes, tonsiks and follicles at the base of the tongue, and of the, intestines; swelling of the spleen and an enlargement of the thymus, the size of which varies; particularly at an age when it has generally disappeared. To all this must bci added a narrowness and delicateness of the aorta and the rest of the arterial system, signs of acute dilatation of the heart with a soft pale heart muscle; whieh occasionally shows signs of degeneration. These are, according to Paltauf, the signs of the lymphatic-chlorotie constitution; whieh one calls in short, the status lymphaticus.
It should be remembered that the hyperplasia of the thymus is only a symptom of the above-mentioned condition, and that it does not act locally as a cause of death; but only marks its bearer as a partic ularly vulnerable individual. This cloetrine has at last been accepted by the clinicians. Among other pediatrists, Pott and Escherich have chiefly helped it gain popularity.
Kassowitz is fully ju.stified in calling attention to the spasm of the larynx and particularly to the expiratory optima; which plays a role in most of the sudden deaths occurring in early childhood; for this is indeed the time when neurotic conditions and rachitis, together with tencler age, render the little patient liable to attacks of laryngeal spasm; and this is the time when these shocking deaths occur.
The acceptance of the theory, even when the conclu.sion is missing; when the death has occurred at the time of the first seizure is also worthy of notice; and Thiemich essentially puts himself on record as holding similar views.
But why clo only certain children succumb to such attacks, and how shall We explain the sudden deaths which occur sometimes in older children, and even oecasionally in adults ill with infectious diseases of a fulminating malignancy? H OW shall we explain the question lately raised by Feer, as to death from eczema? As clinicians we cannot agree with Richter's sceptical views and must therefore consider the hy pothesis of Paltauf as a considerable advance, in spite of the above arguments not being quite convincing.
The status lymphaticu.s which after the excellent teachings of Escherieh, presents a familial' picture to every pediatrist is a useful link, binding together all these clinical experiences and theories. This condition is generally found in well nourished, small, pale, somewhat puffed up looking children. Their superficial glands, spleens and the glands of their necks are enlarged. Dulness on percussion over the thymus is often easily made out. Rachitis and scrofulosis are often present. A large contingent suffer from prurigo, chronic eczernas and spasm of the larynx. In some of these cases trifling therapeutic en croachments, or acute infections where ordinarily the prognosis would be good, end in death. Escherich has tried to explain this constitutional anomaly as analagous to the strutuous cachexia present in so many cases of exoplithalmie goitre. He claims that this condition is a con sequence of the disturbance of the functions of the thymus. Many experhnents and inquiries, particularly the observations of Svehlas seem to support these explanations; but of course, they all remain debatable. One might point out the finding of an enlarged thymus in many chronic constitutional diseases; particularly in cases of endog enous poisonings; as an expression of defense on the part tbe organism; but after all these findings open up the possibility of accepting the status thytnicus as a similar poisoning from which the organism protects itself by hyperplasia of its reserve forces; the lymphatic apparat 118.
. The absence of the thymus does not seem to play much of a role in the pathology of children. It. is hardly worth mentioning. If absent, it is in those cases where there is a deeply inherent deformity of the rest of the body; whieh at once precludes a long life. The few eases on record of absence of the thy-mus belong to the older literature anti have no significance.
III. Atrophy of the thymus is the normal finding in cadavers after severe chronic illness, and also in the cadavers of badly nourished individuals. The attempt therefore of Seydels to make the atrophy of the glands, forensically, a sign of exhaustion; as for instance, death from inanition, has to be declined, on account of its being open to a great variety of explanations.
Thymitis.—Aeuto inflammation of the gland with the forma tion of abscesses was formerly seemingly frequently established by post mortem, the examiners having mistaken another fluid for pus. However, genuine abscess of the thymus does happen 110W and then in the course of pyaimic processes in young children. one thing I have noticed is that after a severe tracheotomy-, followed by a foul condition of the wound, the thymus never appears affected. Abscess never forms.
V. Tuberculosis of the thymus is also of no clinieal importance. On the dissecting table, one sometimes finds it in eases which have succumbed to an acute miliary tuberculosis or a chronic tuberculosis. If careless, one might easily- be deceived and think the ease primarily one of tuberculosis of the thymus, if caseated lymph-nodes are fused together with it.
VI. Syphilis of the thymus is only of theoretical interest.. Accord ing to Schlesinger this gland is affected in cases where the disease is general, in about 40 per eent. of the cases. The most frequently found manifestation is a diffused cellular infiltration; whieh is followed by shriveling.. Occasionally one finds ginnmata which sometimes soften considerably, but the characteristic abseess first described by- Dubois. has nothing to do with the syphilitic lesion and is only to be con sidered, according to Chiari, as systemic. The multifold appearances of this condition were well known to Bodnar. Hmnorrhages also, are described by a few authors as characteristic of syphilis.
VII. Tumors of the Thymus. —Since the careful separation of the thymus from the mccliastinal lymph-glancls, it is very rare to find a ease of malignant disease of the thymus alone. The differential diag nosis for proof of primary cancerous disease of the thymus is practically impossible; for in all these cases the symptom-complex is that of a mediastinal tumor of the lymphosarcoma variety. Finding the Hassalls corpuscles and polymorphic cells in a tumor of the thymus, direetly behind the sternum, has been thought proof by some, that the tumor developed primarily in that gland, but even this is not sufficient proof.
A fen- cases of lympluemia with primary hyperplasia of the thymus have been reported,