228 THE DISEASES OF THE THYMUS GLAND 



or complete extirpation of the thymus gland became greatly relieved of their 

 oppressive symptoms. Klose and Vogt have collected eight such cases. The 

 first case was operated on by Rehn (reported by Parucker}. It was that of a 

 two-and-a-half-year-old child. Since that time a series of other cases have 

 been operated on (see the literature in Wieset). Especially to be mentioned 

 is the case of Hinrichs in which the hyperplastic thymus gland led, in addition 

 to a hindrance of breathing, to a high-grade disturbance of the ingestion of 

 food. Lately the action of the X-rays has also been recommended (Fried- 

 lander, Myers, Rachford, Ribideau and Weil) . The case of Ribideau was that 

 of a two-month-old child with marked need for air on account of hyperplasia 

 of the thymus. After extensive irradiation with X-rays the dyspneic mani- 

 festations disappeared within two days; somewhat later the child died 

 from measles. The autopsy showed fibrous atrophy of the thymus gland. 



The attacks of dyspnea, cyanosis, stridor, and eventually hoarseness, that 

 were observed in all these cases speak indeed for a purely mechanical factor. 

 Whether in the pure cases of status thymicus in addition to this mechanical 

 factor there exists a toxic factor on account of hyperthymization we must for 

 the present leave undecided; although I have hardly been able to discover any 

 grounds for this assumption. Up to the present the cases of Basedow's dis- 

 ease in which death occurred suddenly in narcosis regularly showed in ad- 

 dition to thymus hyperplasia a pronounced status lymphaticus and were in 

 addition complicated by other factors. 



It should be mentioned further that the thymus gland can also be the seat 

 of malignant tumors or of inflammatory processes. The numerous thymic 

 tumors thus far observed have not furnished any information as to the physi- 

 ology of the gland, v. Neusser described a case of sarcoma of the thymus 

 gland ; a twenty-five-year-old patient was remarkably large and showed hy- 

 perplasia of the genitalia. A short time ago we observed a case of carcinoma; 

 here also there existed gigantism; the development of the genitalia 

 was, however, entirely normal. There should also be mentioned the case of 

 Bramivell in which was found, in addition to the sarcoma of the suprarenal 

 gland, a carcinoma of the thymus. Finally in numerous, but not all, cases of 

 myasthenia gravis there were found hyperplasia of the thymus gland and 

 alterations in the muscles that were regarded as lymphosarcoma. This in- 

 terpretation is not however certain, as HassaVs corpuscles occur in the 

 muscle metastases. In these cases we are dealing rather with reticulum 

 tumors. 



If our trying to draw a resume out of the facts detailed, we find that it 

 cannot be denied that in spite of the enormous labor that up to the present 

 has been spent on this subject, the physiological significance of the thymus 

 gland is still unclear. The destruction of the organ through tumors or in- 

 flammatory processes which have otherwise furnished us with so much im- 

 portant information in the pathology of the other ductless glands is here 



