382 ANDKE CKOTTI 



Usually such a congestion can be easily detected at postmortem ; it may 

 have disappeared entirely, however, the gland appearing to be absolutely 

 normal. 



Edema of the thymus may be observed not only in generalized edema, 

 but in localized conditions also, such as infections of the walls of the 

 chest, and of the mediastinal space. When large saline injections are 

 given in the pectoral region, just before death, marked edema may be 

 found in the thymus. 



Hemorrhage. (1) Ilemorrhagic Cysts of the Thymus. This con- 

 dition was first called by Friedleben, "apoplexy of the thymus." It 

 usually occurs in the newborn. It is characterized by sudden hemorrhages 

 taking place in the thymus. It is not a parenchyma hemorrhage, but is a 

 bleeding taking place in a preformed cavity composed of a wall with a dis- 

 tinct lining membrane, whose epithelium is usually flat, but which some- 

 times happens to be cylindrical, thus suggesting that the cystic cavity is 

 due to remnants of thymic ducts. A coincidence of remarkable sig- 

 nificance is that these hemorrhages occur usually in conjunction with 

 congenital syphilis. At least, the cases reported by Barensprung, Hitter 

 and Raudnitz, Schlesinger, Mendelsohn, Bednar, and Sultan, were all 

 syphilitic cases. Is there a relation of cause to effect between these two 

 conditions ? This is very probable, and most likely the immediate cause 

 of the bleeding is due to the rupture of some blood-vessel caused by luetic 

 endarteritis. 



(2) Diffuse Hematoma of the Thymus. This takes place in older 

 children and in adults as well, and usually occurs in conjunction with 

 acute diseases, although it may happen without any apparent cause. The 

 hematoma is not limited by a well defined membrane as in cystic hema- 

 tcma, but permeates diffusely the thymic tissue, involving a greater or 

 lesser portion of it. In rare cases the whole thymus has been found 

 involved; it appears then like a total infarctus of the gland. 



(3) Punctate Hemorrhages of the Thymus. Small punctate hemor- 

 rhages are frequently observed in the thymi of new-born and of young 

 children dying from acute infectious diseases as whooping cough, pneu- 

 monia, hemophilia, convulsions, sepsis, etc. Dudgeon found hemorrhages 

 in the thymus in 95 per cent of the deaths following bronchopneumonia 

 and lobar pneumonia. The same type of hemorrhage is observed, too, in 

 cases of difficult delivery especially in malpositions of the fetus followed 

 with rotation, and forceps application. Attention to these cases was called 

 by Weber in 1842, and since then various obstetricians have reported 

 similar cases. Hemorrhage in such cases is characterized by a rather 

 punctiform aspect involving the whole gland and extending to the neigh- 

 boring structures, such as the pleura, pericardium, etc. The hemorrhagic 

 point, however, may be as large as a pea, or larger. Under such condi- 

 tions the thymus is much enlarged, has a firm consistency, hence, pressure 



