PATHOLOGY OF THE THYMUS 383 



upon the trachea and upon the mediastinal organs, hence, suffocation. 

 Syphilis in these cases is not an etiological factor. 



In 1909, Winkler reported a case of a four days old child who had 

 undergone a forceps delivery, and who died four days after birth with 

 symptoms of suffocation, although he had been apparently well up to that 

 time. Postmortem showed a large hematoma of the thymus caused prob- 

 ably during the delivery. Another hematoma was observed in the right 

 cerebral hemisphere, thus showing that the mechanical origin of the thymic 

 hematoma was very probable. 



Acute Thymitis. A primary thymitis has not yet been reported. 

 The very rare cases so regarded are doubtful. On the other hand, acute 

 thymitis, secondary to metastatic infections following some other acute 

 focal process, has been observed more than once. Schridde, for instance, 

 reported an abscess of the thymus following a retropharyngeal abscess. 

 The same was also observed by Hutinel and Tixier, Roger; Ghika, and 

 Klein after diphtheria and syphilis. 



In 1914, McWalter reported a case of acute thymitis in a child, twelve 

 months old, who had previously been healthy. Within the previous eight 

 days, however, he had developed a swelling at the suprasternal notch 

 which extended upward as far as the hyoid bone and spread laterally as 

 far as the middle third of the clavicle on each side. There was a distinct 

 dullness over the upper part of the sternum. The swelling was uniform, 

 smooth, homogeneous, not hot, and not painful to the touch. There was 

 some redness of the skin, but no sign of suppuration. The child suf- 

 fered from dyspnea. The appearance of the child, rather than the gravity 

 of the symptoms, alarmed the mother. A solution of oil of wintergreen in 

 almond oil (20 per cent) was applied to the swelling and rapid improve- 

 ment had set in, when suddenly the child ceased to breathe and death oc- 

 curred suddenly and painlessly about the fourth day of the treatment. 

 Here the absolute proof, namely postmortem, that this case was really an 

 acute thymitis, is lacking. 



The organisms most frequently found in thymic abscesses are the 

 staphylococcus, the streptococcus, and the colon bacilli. Metastases take 

 place through the hematogenous route. Localization of the abscess may 

 take place either in the parenchyma or in the existing cysts. Diagnosis 

 in these cases is made by taking into consideration the pressure symptoms 

 due to tracheostenosis, the temr>erature, pressure-pain upon the sternum, 

 leukocytosis, and polynucleosis. X-ray may be of great value. These 

 abscesses are usually located in the mediastinal portion of the thymus; 

 any surgical attempt to relieve the patient is consequently difficult and dan- 

 gerous. It is, however, the only possible means of giving the patient relief. 



Acute Infections and Thymus. That the thymus undergoes hyper- 

 plasia in acute infections was already noticed in 1847" by Herard, who 

 based his conclusions upon sixty postmortems. 



