CLINICAL SYNDROMES (STATUS THYMICUS, ETC.) 411 



If this be accepted as a working hypothesis, separate treatment of the 

 thymic hyperplasia, would not be demanded in cases of exophthalmic goiter. 

 But on the contrary, we should expect the sympathetic system to return to 

 normal in all except the worst cases as soon as the parasympathetic system 

 had regained its tone. But in these worst cases cases in which the thymus 

 has become a positive influence in the bodily economy the radiologic 

 treatment of the thymus is certainly indicated. 



Myasthenia Gravis 



Nature of the Disease. This syndrome was recognized by Erb in 

 1891, and its definition has been given greater precision by several 

 succeeding writers, e. g., Goldflam, Buzzard, Oppenheim, Weigert, Jolly. 

 At present the widest acceptance is accorded to McCarthy's formu- 

 lation of the definition: ". . . a disease with fatigue symptoms refer- 

 able to the muscular system, due to an exhausted condition of the 

 innervation, without definite pathology in the nervous system and with 

 minor changes (lymphocytic infiltration) in the muscles." While 

 the ocular muscles may be the first, or those most prominently involved, it 

 may be limited to the movement of the limbs (Anders-Boston). In the 

 morning, or after a long rest the movement of the affected muscles may be 

 almost normal. But they soon tire. The usual clinical test of the condi- 

 tion is to stimulate the muscles with the faradic current. After a few 

 apparently normal contractions, the muscle ceases entirely to respond 

 (Jolly). This muscular weakness has frequently led observers to classify 

 their cases under the paralyses, and. thus to lose sight of their true signifi- 

 cance; e. g., Major's case was reported simply as leukemia with paralyses. 



Occurrence of Thymic Tumors in Myasthenia Gravis. In 1901, 

 Weigert reported the finding of a thymic tumor in two cases of myasthenia 

 gravis. Since then many more have been reported. Thus Mandelbaum 

 and Cellar collected reports of eleven thymic lesions in a total of forty-five 

 cases. The study of these tumors had not led to unanimity of opinion 

 until Ewing'(a) and Bell (&) showed that they are essentially derivatives 

 of the embryonic thymic tissue. Ewing, therefore, calls them thymomata. 

 Whether or not the lymphorrhages in the muscles and visceral organs are 

 to be ascribed to an excess of thymus lymphocytes, or whether both have a 

 common origin as a reaction to a diffused toxin remains unsettled. 



Illustrative Case. Jones' case was so well studied that it is worth 

 while to reproduce here the history: "To the best of the patient's knowl- 

 edge, he was in perfectly good health three years before. About May, 

 1912, following an exposure to cold while working in water as a ship's 

 carpenter, he noticed within a few days a marked weakness of his neck 

 muscles, and within two weeks he had developed a condition similar to the 



