80 ^^^ Philippine Journal of Science ms 



able that there are two classes of cases; one in which the con- 

 dition is a pure status lymphaticus in the sense of Paltauf, and 

 another in which the various changes are more or less caused 

 by the disease with which they are associated. 



Kolisko(lO) has given the best description of the anatomical 

 conditions found in cases of pure status lymphaticus, while Von 

 Neusser(7) has probably furnished the best data on which to 

 base a clinical diagnosis. 



For the diagnosis of status lymphaticus in the cadaver, Kolisko 

 has given the following signs : 



1. The failure of the involution of the lymphatic organs which otherwise 

 occurs regularly at puberty. The enlarged tonsils consist of lymphoid 

 tissue while their epithelial crypts are small; the follicles at the base 

 of the tongue cause by their enlargement a rough granular condition of 

 that part, the upper part of the pharynx is beset with lymphoid nodules 

 as large as peas, mostly in the pharyngeal vault, but also on the posterior 

 pharyngeal wall, in the pyriform sinuses, and even in the larynx on the 

 inner side of the epiglottis. 



2. The cervical lymphatic glands are bean-size to, at the most, cherry-size, 

 tolerably firm and mostly pale, sharply circumscribed one from the other. 



3. The thymus persists beyond puberty, and frequently undergoes 

 hyperplasia. 



4. The endocardium of the left ventricle shows a diffuse cloudiness on 

 the valves, the mural endocardium, and in the heart muscle, without 

 inflammatory manifestation. The alterations in the lining of the heart lead 

 Kolisko to conclude that abnormal pressure with a tendency to dilatation 

 has been acting on the ventricular endocardium. 



5. The enlarged spleen shows hyperplastic follicles on the cut surface, 

 and its capsule is tense and often very friable. 



6. The mucosa of the intestine shows distinct hyperplasia of the follicles, 

 and the mesenteric lymphatic glands are proportionately enlarged. So are 

 all other lymphatic glands of the body enlarged in various degrees, the 

 smaller being mostly rich in blood, the larger bloodless and not juicy. 



7. The bone-marrow frequently exhibits the appearance of medulla rubra. 



8. As the size and weight of the thymus normally are .subject to re- 

 markable alterations and as the other lymphoid tissue of the child's 

 organism is so variable in its growth, and hyperplasia of it is so frequent 

 as the result of inflammatory irritation or disturbances of nutrition as in 

 rickets, it is clear that the interpretation of the pathologico-anatomical 

 findings in relation to the diagnosis of status lymphaticus in the cadavers 

 of children up to the sixth year is beset with extraordinary difficulties. 

 Therefore, for diagnostic purposes one must emphasize the occurrence of 

 the size of the thymus, disproportionate to the age of the child, as well as 

 the frequency and similarity of the hyperplasia in the lymphatic system, 

 and also the condition of nutrition must be borne in mind. 



9. A frequent, but not constant, finding is the narrowness and delicacy 

 of the aorta and the rest of the arterial system, yet hypoplasia of the 

 arteries can exist even without a macroscopically recognizable hyperplastic 

 lymphatic system. Also, the hypoplasia of the genitals often accom- 



