CLINICAL SYKDEOMES (STATUS THYMICUS, ETC.) 401 



the enlargement of the thyroid disappeared coincidently with the shrinkage 

 of the thymus. X-ray plates two and ten weeks after treatment showed a 

 normal thymic outline. The child was still perfectly well after fifteen 

 months after discharge from the Hartford Hospital. 



Since the cause, if mechanical, must cease to operate when the chest 

 expands, thymic asthma could be a disease only of infancy. This agrees 

 with clinical observation. 



Our conclusion must be then that the hyperplastic thymus may cause 

 tracheostenosis, and that this does occur occasionally, especially after cry- 

 ing or other disturbance that leads to an engorgement of the mediastinal 

 tissues. 



The presence, therefore, of a hyperplastic thymus should be looked 

 for whenever an infant is being examined. In the infant this can be 

 fairly accurately done by finger percussion, and all doubt can be settled 

 by using the X-ray. (The technic of this procedure will be discussed 

 below. ) 



In the presence of such a hyperplastic thymus, drastic medical and 

 surgical procedures should be undertaken with great caution, and if 

 practicable, only after the use of therapeutic doses of the X-ray or radium. 



Mors Thymica 



It was the^occurrence of sudden death in previously apparently healthy 

 children that first called attention to thymic hyperplasia. Thus, Grawitz 

 (1888) could find no explanation other than the pressure of the thymus 

 on the trachea in two cases observed by him. But in other cases the thymus 

 did not seem large enough to exert a, deleterious pressure. Consequently 

 there have arisen two theories in explanation of thymic deaths: the one 

 mechanical; and the other chemical (or anaphylactic). 



The adherents of the mechanical theory point to many clinical obser- 

 vations of very evident asphyxiation. Such an observation is that of 

 Chevalier Jackson, quoted in a previous paragraph. Another is that of 

 Douglass, who writes the following vivid description : 



". . . the dyspnea was much worse, stridor increased, cyanosis rap- 

 idly increasing, face becoming anxious, and all features of the case pre- 

 senting a grave aspect. We decided that tracheotomy offered the only pos- 

 sible chance of relief. ... A few whiffs of chloroform were given, and as 

 the initial incision was finished, the chloroform withdrawn. The subcu- 

 taneous fat was abundant. There was no oozing of blood following the 

 cut. Her heart was racing, a pulse count impossible. As soon as the cut 

 was extended through the fat the thymus filled the wound completely, and 

 extended as far above and below as could be felt. It was deep purple-red 

 in color, covered with small hematomata from about 2 mm. to 6 or 8 mm. 



