408 GEOEGE H. HOXIE 



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affected. Thus, we have the Dubois abscess (Oliver), or the diffuse small 

 cell infiltration of Schlesinger, or the gummata (which may break down 

 into cysts) . In no cases thus far reported has there been a status lymphat- 

 icus connected with such findings. 



Subjective Symptoms. Finally, as to the effect of the status thymicus 

 on the patient, the following statement from Houghton (a) is pertinent: 

 "It is evident from my cases that this myasthenia is a most character- 

 istic symptom of status thymicus. The typical history as given by a 

 patient recently is, *I awake in the morning feeling splendidly, though 

 the night's sleep may have been poor. My first thought is as to how 

 much I can accomplish during the day. After a good breakfast, I take a 

 walk as I have been advised to do, and before I have gone two blocks I 

 begin to feel tired. If I continue, I am compelled to sit down and rest 

 before a half mile is covered, and for the rest of the day my strength is 

 gone.' ' 



It is well to contrast this with the story of the typical neurasthenic, 

 whose worst time is in the morning and whose only joy in living comes 

 later in the day. Much confusion and also much unhappiness has arisen 

 from the failure to make the differential diagnosis between these two 

 fundamentally different conditions. This consideration emphasizes the 

 necessity of making a general physical examination of all patients, even 

 though they seem to present only functional and neurotic symptoms. Even 

 in the adult, the status thymicolymphaticus calls for protective hygiene 

 and extra stimulation. 



Hygiene. In the way of hygiene, the protection from overstrain, 

 both physical and mental, is of primary importance. Growing children 

 must be protected from the grind of the regular school curriculum. They 

 must have shorter hours and more frequent vacations than the average 

 child. In particular, it is wise to send them every year to the mountains 

 for the effect of the altitude in expanding their chests and strengthening 

 their weak arterial systems, In my practice I have seen children prac- 

 tically transformed by spending eight to twelve weeks each year at an alti- 

 tude of six thousand feet or more. This should be continued until the 

 thymic involution at puberty aids in the reduction of the organ to a size 

 relatively smaller than its mediastinal container. 



Even after puberty, it is important that these patients should not be 

 allowed to dissipate their strength either in school or social excesses. If 

 they engage in business or professional life, they must be taught to respect 

 the signs of overstrain and curb their ambition to fit their strength. 



In the way of stimulation I have found nothing quite as effective as 

 arsenic, especially when it is administered intramuscularly in the form of 

 sodium cacodylate, or arsacetin. 



