PATHOLOGY AND SEMIOLOGY 227 



The question is not completely cleared up at the present day although the 

 direction in which we may expect the clearing is indicated. What makes the 

 question especially difficult is the circumstance that status lymphaticus and 

 enlarged thymus gland occur so frequently in associationship. Apparently, 

 however, they stand to each other in a conditioned relation. As we shall see 

 later in another paragraph, the finding of an intumescence of the lymphatic 

 apparatus eventually with a mononucleosis in the blood is very frequent in- 

 deed. We find this in numerous diseases of the ductless glands, in chronic 

 infectious diseases, in neurosis of the vagus nerve, etc. These hyperplasias 

 deviate markedly from one another histologically. In addition, it is per- 

 fectly clear that not every chronic swelling of the lymphatic apparatus is 

 associated with increased chemic function. Also the thymic hyperplasia or 

 thymic persistence or reviviscence is extraordinarily frequent just in these 

 diseases of the ductless glands. If we accept the view that the thymus 

 gland is in part of mesodermal origin, therefore in part belongs to the lym- 

 phatic apparatus, this frequent combination of enlarged thymus gland and 

 status lymphaticus would not be inexplicable. There certainly exists, 

 however, an abnormally large thymus gland without status lymphaticus, 

 hence a status thymicus. 



Recent investigations seem to have furnished a significant differentiating 

 criterion. Wiesel and Hedinger have shown that status lymphaticus is asso- 

 ciated with a hyperplasia of the chromaffin tissue. Thus Hedinger found in 

 five cases of pure thymic hyperplasia entirely normal development of the 

 suprarenals and the entire chromaffin tissue, also on microscopical exami- 

 nation. Again, v. Sury points out that in the so-called thymic death of the 

 new-born the chromaffin tissue is always well developed and that the hypo- 

 plasia of the chromaffin tissue sets in only with the development of status 

 lymphaticus. In cases of pure thymus hyperplasia the lymphocytosis of the 

 blood would seem to be absent. 1 



Let us now turn again to the question of thymic death, v. Sury has 

 treated this subject in an elucidative exposition, one especially adequate on 

 account of its rigid critique. He bases his conclusions on the material of two 

 hundred medicolegal autopsies in which the thymus gland was taken into 

 account, v. Sury shows first that the thymus gland varies extraordinarily 

 in size and that therefore the diagnosis of a thymus hyperplasia is often very 

 arbitrary. He mentions further that in the cases of sudden death in children 

 apparently healthy beforehand there exists very frequently capillary bronchi- 

 tides which are very common and which are very easily overlooked. In spite 

 of this we can hardly deny the significance of the mechanical factor in the 

 cases of "thymic asthma " published in recent years cases which after partial 



1 Often in pure status thymicus the epithelial thymic tissue, that is, the reticulum and its 

 derivatives, is found hyperplastic while the small thymic cells do not necessarily have to be in- 

 creased, in contrast with status lymphaticus (Wiesel). 



