THE SYMPATHETIC SYSTEM 123 



At the autopsy of certain children dying of thymic 

 accidents, the gland has been found very slightly enlarged 

 or not at all. In these cases, these accidents can be ex- 

 plained by an abnormal conformation of the superior 

 opening of the thorax. The latter is bounded by a sterno- 

 costal-vertebral belt. The space between the sternal 

 manubrium and the 7th cervical is the critical space de- 

 scribed by Grawitz and has a diameter in the new born 

 which varies between 2 and 2 :5 cm. Following a congeni- 

 tal malformation or a rachitic deformity of the ribs, this 

 diameter may be narrower than normal. Under the 

 influence of many factors, notably the extension of the 

 head, the thymus, which is a mobile organ and follows 

 the movements of respiration, becomes strangulated in 

 this body space. This strangulation causes a congestion 

 of the gland ; it increases in size, compresses the large vessels 

 and the trachea and results in respiratory disturbances. 



II. SUDDEN DEATH OF THYMIC ORIGIN. 



Next to the thymic symptoms due to asphyxia, which 

 are particular to childhood, there are certain types of 

 syncope which are to be found at all ages. 



1. IN THE NEW BORN OR YOUNG INFANT. These 

 occur at night without any premonitory symptoms. The 

 infant goes to sleep at night and the next morning is found 

 dead in bed. It is usually believed that the child has 

 been smothered under the bed clothes or that a crime 

 has been committed. Autopsy reveals a hypertrophy of 

 the thymus. Sometimes these sudden deaths do not 

 occur in isolated cases. Griffith recently reported a 

 family in which 7 out of 8 children died suddenly. 



2. IN OLDER CHILDREN OR IN ADULTS. Sudden death 

 of thymic origin sometimes also occurs, the patient being in 



