CLINICAL SYNDEOMES 343 



disease thymus has shown marked hyperplasia of the medulla of the gland, 

 the presence of many Hassall's corpuscles and accumulations of eosino- 

 phils along the septa of the gland and about the blood vessels. Capelle 

 and Bayer believe that both the thyroid and thymus produce an internal 

 secretion that there are two components, one sympathicotropic and one 

 vagotropic. They believe that variations in the proliferation in both the 

 thyroid and thymus will account for the manifold types of Graves' disease 

 that one meets with clinically. The thyroid influence is, on the whole, 

 predominantly sympathicotropic in contrast to the thymic effect which is 

 predominantly vagotropic. Indeed, some observers believe in the possi- 

 bility of Graves' disease being due primarily to disease of the thymus. 

 It is maintained that thyroid intoxication leads to hyperplasia of the 

 thymus and thymus intoxication to enlargement of the thyroid. We are 

 inclined to accept the conservative view of Mackenzie, who writes : "What 

 part the persistence of the thymus gland plays in the disease is at present 

 uncertain. The possible relationship of the exophthalmic goiter to the 

 condition known as lymphatism or status lymphaticus has to be consid- 

 ered . . . It is significant that a persistent thymus is found in so large a 

 proportion of the cases of exophthalmic goiter which succumb under 

 operation." 



According to Launoy, Bircher has claimed to have experimentally 

 reproduced in dogs Graves' disease by an intraperitoneal implantation 

 of portions of the thymus gland removed from non-goitrous persons dying 

 under an anesthetic. Against such claims Launoy points out that the 

 success of thymectomy in exophthalmic goiter has not been demonstrated, 

 nor does experimental removal of the thymus result in atrophy of the 

 thyroid. According to Epplnger, Falta and Hess, as well as Capelle and 

 Bayer, the particular symptoms which indicate a preponderate influence 

 of the thymus gland in Graves' disease are the vagotonic. Halsted (<?) (e) 

 rather questions this last statement in his interesting paper on the signifi- 

 cance of the thymus in Graves' disease. Klose believes that in Graves' dis- 

 ease the thyroid is qualitatively and not merely quantitatively altered and 

 may cause toxic as well as mechanical injury to the heart ; Matti, how- 

 ever, states that there is no relationship between the thymus and cardiac 

 hypertrophy. Further, Klose and Borchhardt attribute the lymphocy- 

 tosis of Graves' disease to the thymus, but in this they have not the 

 complete support of Halsted. We believe we cannot do better in closing 

 this discussion than to quote directly from Halsted: "From the facts 

 gleaned at the autopsy table, from experiments on animals and, above 

 all, from the result following primary thymectomies we have convincing 

 evidence that the thymus gland may play an important part in Graves' 

 disease and in some cases assume the title role. Some of the most puz- 

 zling features of the disease are made possible of interpretation by the 

 discovery of the influence which the thymus may exert." 



