402 GEOKGE H. HOXIE 



in diameter, 'its blood vessels were large and tortuous. It was distinctly 

 lobulated. It filled the -space in front of the trachea completely, and was 

 so intimately adherent to the structures below that it could not be drawn 

 aside to expose the trachea. The only way the trachea could be reached 

 was by cutting through the gland substance. This was attempted, but on 

 trying to sponge away the blood, it would well up and fill the wound, ren- 

 dering a clear operative field impossible. This so delayed the operation 

 that we could not get an opening into the trachea before death ended the 

 scene. " 



On the other hand, we find such reports as this, from Thursfield (a) : 

 U A boy aged thirteen months suddenly sat up, his eyes became fixed, he 

 ceased to breathe, became very slightly blue, and then quite white, 

 and fell back dead. The whole series of events occupied less than thirty 

 seconds. 7 ' 



Another case, this one from Falls, will show how very puzzling is the 

 problem. "The baby breathed without difficulty until two hours after 

 birth, when the respiration became difficult and the child cyanotic. This 

 condition lasted for two hours when the cyanosis deepened, respiration be- 

 came more difficult and the child died without convulsions. Before and 

 after birth the heart sounds were normal ; just before death the pulse went 

 down to 30 per minute. At autopsy the skin of the head, neck, arms and 

 thorax was red and congested. The head showed no signs of trauma. The 

 pericardial sac contained a large amount of serosanguineous fluid, and the 

 left lung was compressed and pushed to one side by a large thymus 4 cm. 

 broad at its widest part, and 5.5 cm. long. Crossing the upper portion of 

 the thymus, from left to right at the upper border of the clavicle to the 

 level of the lower border of the first rib, was the left innominate vein. This 

 had compressed the thymus and lay in a groove on its surface. A branch 

 of this vein left the thymus at about the midline of the body. There was 

 no evidence of thrombosis in the thymic veins, the left innominate or supe- 

 rior vena cava. There was edema of the posterior portion of the lung, 

 more marked on the left side, and there were small hemorrhages on the sub- 

 stance of the kidneys. Histological examination of the hypophysis, thy- 

 mus, thyroid, adrenal and spleen revealed no abnormalities. The trachea 

 was opened just above the upper edge of the main portion of the gland. 

 There was evidence of compression of the trachea by the main body of the 

 thymus, as shown by the difficulty in passing a probe downward from the 

 opening." 



1 laminar is quoted by Goi'don as showing that the mechanical cause 

 was not operative in cases of thymic death. Thus he examined sixteen 

 cases and found the size and histology no different from that in an equal 

 number dead from other causes. Against the validity of Hammar's rea- 

 soning, Jackson points out that the condition post mortem does not parallel 

 the condition in vivo, in that the congestion is absent, and the tissues (in- 



