STATUS HYPOPLASTICUS 367 



development become more or less inhibited. In childhood, as already //. 

 Kundrat mentioned, rachitis leads to lymphatism not infrequently, as do also 

 tetany, the exudative diathesis, especially scrofulosis, and a series of other 

 infectious processes. In adolescent and adult individuals occasion is given 

 for a temporary or a permanent lymphatism by the vagal neurosis, bronchial 

 asthma, chronic infectious diseases, especially lues and tuberculosis, osteo- 

 malacia, and especially the affections of the ductless glands. In a great num- 

 ber of cases perhaps there occurs at first, through chemotactic influences, only 

 a slight mononucleosis of the blood, and only later a slight hyperplasia of the 

 lymphatic apparatus, therefore a forme fruste; in other cases, especially in 

 many formations of ductless glandular affections, the hyperplasia of the lym- 

 phatic apparatus may be fully developed. Of the ductless glandular diseases 

 should be mentioned especially Addison's disease, myxedema, Basedow's dis- 

 ease, acromegaly, tetany, and dystrophia adiposo-genitalis. Also in some 

 cases that we must regard as true eunuchoids we found appreciable mononu- 

 cleosis of the blood. It is self-evident that mononucleosis is a symptom with 

 many meanings, and in itself speaks nothing for the diagnosis of status lym- 

 phaticus. Thus we found it strikingly present also in many severe forms of 

 diabetes mellitus in which autopsy showed no status lymphaticus. It is very 

 probable that under secondary lymphatism are concealed numerous and di- 

 verse conditions, in part chronic inflammatory in nature, the differentiation 

 of which perhaps can first be made by a careful microscopical examination of 

 the lymphatic apparatus. 



The great difficulty in the diagnosis of status lymphaticus in vivo is made 

 prominent in the comprehensive exposition of this subject brought out a short 

 time ago by V. Neusser. v. Neusser relates how important it is to have in 

 mind, in consideration of the minute factors, the possibilities of an existing 

 status lymphaticus, because the infectious diseases and especially the most 

 diverse noxious agents frequently take on a characteristic expression on 

 the ground of this constitutional anomaly and often pursue their course 

 unfavorably. 



B. Status Hypoplasticus 



In several works, Bartel has indicated a form of developmental disturbances 

 that he designates hypoplastic constitution. It is frequently, but not always, 

 associated with status lymphaticus. The body size of such individuals is on 

 the average normal. Often the fatty tissue is very well developed. There is 

 found hypoplasia and narrowness of the vascular system and poverty of the 

 smooth musculature of the aorta (Wiesner), and in addition faulty develop- 

 ment of the sexual glands and secondary sexual characters. The sexual 

 glands are indeed of normal size, the ovaries often even enlarged; microscop- 

 ically there is found, however, proliferation of the connective tissue (Herrmann 

 and Kyrle) . When status lymphaticus is present an atrophic stage can follow 



