412 GEOEGE H. HOXIE 



one from which he suffered when examined. The symptoms came on 

 rather slowly, and were associated with slight pain and soreness in the 

 muscles of the shoulder and back of the neck, followed by general muscu- 

 lar weakness, and particularly by inability to close the mouth, to swallow 

 solid foods, or to drink liquids. This condition progressed until the 

 patient became much emaciated, and was almost unable to take nourish- 

 ment at all. This illness lasted a few weeks, when he began to improve 

 and recovered his strength. Within six months after the onset of his pri- 

 mary symptoms, he claimed that he was perfectly well, and during the 

 interim he did not recall that he had felt any weakness of muscles or any 

 inability to swallow or to speak. Up to February, 1915, he was in his 

 usual good health, and was able to attend to his work. During this month, 

 without apparent cause, unless it was a slight cold, as he expressed it, fol- 

 lowing exposure, the above named symptoms began to return. There was 

 pain in the jaw, but not of severe type. Gradually the muscles of the neck 

 and throat became weak, and he was unable to move his jaw, or to swallow 

 or drink with his usual ease. At the time of his admission into the hos- 

 pital, in November, 1915, he had a slight ptosis of the right eyelid. The 

 weakness that he complained of was most marked in his neck muscles, but 

 the entire musculature was more or less involved, and during the time that 

 he was under observation he was unable to walk, to make any marked exer- 

 tion, or to eat a full meal. After a good night's rest the patient was much 

 better, but as the day went on his weakness became more marked. At the 

 beginning of a meal, swallowing and other movements of the jaw were 

 comparatively free; but after a few moments the muscles tired, and he 

 was unable to continue. It was difficult for him to blow his nose, and he 

 was obliged to have his mouth closed and his chin held in position until he 

 could force air through the nostrils. After talking for a few moments he 

 was obliged to hold his lower jaw with the aid of his hand. Aside from 

 this general weakness, and particularly of the muscles of the neck and jaw, 

 and his inability to finish his meal, the patient felt fairly comfortable. 

 On December 10, 1915, he complained in the afternoon of a general full- 

 ness of the chest, with evident dyspnea. A hypodermic of 1-200 grain of 

 atropin was given, with the hope that it might relieve his distress. Ten 

 minutes later he suddenly died." 



The postmortem examination was made by Bell, whose previous work 

 on the thymus made him particularly well qualified for the task. The fol- 

 lowing is quoted from his report: "The tumor tissue consists of cells 

 with large vesicular nuclei and abundant light staining cytoplasm, fused 

 together to form a syncytiuni. Throughout the syncytium are numerous 

 spaces of variable shape and size, containing small lymphocytes. In some' 

 areas the lymph old cells predominate, in other areas the epithelial cells. 

 To those familiar with the histogeiiesis of the thymus it will be clear that 

 this tissue corresponds closely to the structure of the embryonic thymus at 



