CLINICAL SYNDROMES (STATUS THYMICUS, ETC.) 407 



vue Hospital, we have not been able to implicate the thymus as a mecKan- 

 ical factor in the production of death, the anatomical signs of tracheal 

 compression and death from suffocation never having been found, though 

 sought. 



". . . It is more probable that death is of the nature of an anaphylac- 

 tic reaction, sensitization being expressed in structural terms of the ne- 

 crotic germinal follicles, and chemically, by the release of nucleoproteids 

 which, though not strictly foreign, are none the less pathological ; and are 

 comparable in a toxicological sense to alien products. Previous to the 

 expiration of the so-called anaphylactic incubation period, the lymph nodes 

 are again subjected to the action of destructive substances which serve to 

 bring about still further disintegration of germinal nuclei, thus providing 

 the requisite quantity of specific proteid to complete the anaphylactic 

 cycle. The destructive substances may be introduced in the form of anti- 

 toxins hypodemrically administered, or as vaccines applied by scarification 

 or otherwise, or as substances which have escaped destruction or modifica- 

 tion by the hyperplastic lymphoid follicles in the intestinal tract, or which 

 have been manufactured in the processes of shock induced by even such 

 simple procedures as the prick of a needle, sudden immersion in cold 

 water and similar events." 



Among foreign writers there is also this same sense of the inadequacy 

 of our present knowledge of the subject. For example, Eriedjung is de- 

 cidedly of the opinion that the term status lymphaticus is justified as 

 affording a serviceable grouping of allied happenings. But he does not find 

 in the German literature any adequate explanation for all the clinical phe- 

 nomena. He reviews the views of Escherich, Thiemich, Rosle, Wiesel 

 and Bartel, and contrasts them with Czerny's desire to throw aside the 

 whole conception and think only in terms of an equally vague "neuropath- 

 ological constitution. 77 



The French are inclined also to speak of diathesis, rather than of status 

 lymphaticus. But Olivier and Veau's writings do add material strength 

 to the theory that the thymus has a causal relation to the general con- 

 dition. 



If the condition were simply constitutional, heredity and environment 

 should play an important role. But only occasionally has the occurrence 

 of status lymphaticus in families been noted. Of these, one of the 

 most complete of the recent reports is that of Bierring, Goodrich and 

 Glomset, treating of four cases in one family. All died suddenly and 

 within a short period ; the authors were able to make thorough postmortem 

 studies. They are inclined to believe that the histologic conditions found 

 were the general reaction of the tissues to some chronic irritation, and thus 

 neither inherited, nor congenital nor even diathetic. 



That status lymphaticus has nothing to do with hereditary syphilis is 

 shown by the distinctive changes found in the thymus when that organ is 



