226 THE DISEASES OF THE THYMUS GLAND 



hand, G. Anton shows the simultaneous occurrence of thymus hyperplasia 

 and brain hypertrophy. 



Lately total extirpation of the thymus gland has been carried out on 

 account of stenosis of the trachea (see below). Very worthy of note is the 

 statement of Koenig, that after resection of the thymus gland such as was 

 undertaken in a nine-month-old child on account of dyspnea, breathing be- 

 came normal and afterwards a severe rachitis developed on account of 

 which the child first learned to walk as late as the age of four and one-half 

 years. In the rest of the cases there are no statements as to the further course. 

 According to the experiences in animals, the experiments up to the present, 

 total extirpation of the thymus gland in very young children is to be advised 

 against. 



Up to the present the entire clinical interest has been turned to the cases 

 which have shown a hyperplasia of the thymus gland and a persistence or 

 reviviscence of the same. 1 Kopp in 1855 first attracted the interest of 

 the medical world to the cases of sudden death in early life which occurred 

 with cyanosis and stridor and which on section showed nothing but hyper- 

 plastic thymus gland. The extensive investigations of Friedleben, which 

 culminated in the aphorism " there exists no thymic asthma," for a long time 

 suppressed this teaching. First in the year 1888 Grawitz on the evidence of 

 two cases pointed out the forensic significance of thymic hyperplasia. Up to 

 this time only purely mechanical factors in these cases of death had been con- 

 sidered. Then, in 1889, A. Paltauf, finding out the frequent combination of 

 thymic hyperplasia, status lymphaticus, and narrowing of the vascular system 

 regarded the cause of death not as a mechanical factor but as a vegetative dis- 

 turbance which he designated as lymphato-chlorotic constitution. Among 

 others, Ortner reported congenital narrowing of the aortic system in these cases 

 of sudden death, v. Kundrat status lymphaticus with more or less large thy- 

 mus gland in cases of sudden death in narcosis, Schnitzler and others narcotic 

 death in cases of Basedow's disease with persistence of the thymus and status 

 lymphaticus. With Pott originated an excellent description of the cases of 

 sudden death in the years of childhood. Most authors agree with the 

 view of A . Paltauf, in that they regard the mechanical factor as without sig- 

 nificance and place in the foreground the lability of the organism or the 

 cardio-vascular system that is dependent on toxic factors. Especially in- 

 teresting are the observations of the familial occurrence of these species of 

 sudden death (Perrin, Hedinger, and others}. Certain authors, however, 

 hold fast to the mechanical cause through compression of the trachea by the 

 thymus gland. 



1 Persistence of the thymus gland is, properly speaking, an incorrect expression as every 

 human being possesses a thymus gland for his whole lifetime. Better than "persistence" is 

 higher parenchymal value than corresponds to the age; also a reviviscence is really not certain, 

 as we do not possess a criterion for it. 



