CLINICAL SYNDROMES (STATUS THYMICUS, ETC.) 403 



eluding the trachea) have fallen back into their normal relations and 

 shapes. 



We are thus left with the realization that in a certain number of cases 

 this sudden death of infants may be due to asphyxiation, but that in other 

 cases we must look to other causes. Inasmuch as these sudden deaths 

 occur chiefly among the victims of the status lymphaticus, we will discuss 

 the possible causes under that head. 



Status Thymicolymphaticus 



Many children enter upon life with such abnormal constitutions that 

 they do not respond to the foods ingested, or to the stimuli of the outside 

 world in the same way as do the great majority. Writers have attempted 

 to classify these abnormalities and analyze their causative factors. Thus, 

 some have revived the terms found in humoral pathology, and speak of 

 diatheses. Others, see in the eczematous skin and deranged digestion 

 evidence of the vagotonia of Eppinger and Hess. Others, like Haeckel, 

 speak of emotivite and the nevrose cTangoisse. But more generally, such 

 abnormalities are being traced to dysfunction of the endocrin glands. This 

 view seems to us thoroughly justified, because the endocrin glands seem 

 always involved in these cases and also because it affords something tangi- 

 ble and adequate for study and classification. Considered from the latter 

 standpoint, the best defined group of such disorders is that designated by 

 Paltauf (in 1889) as the status thymicolymphaticus, thus implicating 

 the thymus in its causation. 



The most thorough studies of this syndrome seem to have been made 

 at the Bellevue Hospital (New York) ; Symmers has presented an ex- 

 haustive report of the findings among the first 4000 postmortem exam- 

 inations in that institution. He 3efines the condition thus : ". . . a 

 combination of hereditary constitutional anomalies, entering into which 

 are certain peculiarities of configuration, with preservation or even hyper- 

 plasia of the thymus gland at an age when involution is to be expected, 

 hyperplasia of the lymphoid cells in the lymphnodes, spleen, intestine, and 

 elsewhere; hypoplasia of the cardiovascular system, developmental defi- 

 ciencies in the genitalia, and, incidentally, visceral defects of uncertain 

 occurrence and irregular distribution." 



Haven Emerson, of the same institution, lays down the diagnostic cri- 

 teria thus: "For the present it seems to me that a diagnosis of status 

 lymphaticus is justified when we find, in the case of a man, a decided 

 scantiness of the hair on chin and upper lip, scanty axillary and sternal 

 hair, scanty or feminine distribution of pubic hair; the slender thorax; 

 the rounded contour of upper arms and thighs, with an arching of the lat- 

 ter; hypoplastic external genitals, particularly if associated with cryptor- 



