Enlargement of the lymphoid tissue in the wall of the alimentary canal also occurs, and in those rings of adenoid tissue which mark the site of the embryonic canals. This tissue may be seen around the origin of the appendix, while its most conspicuous illustrations are seen about the pharynx, where not only the faucial, but the lingual and the pharyngeal tonsils are enlarged. In many of these cases there are the so-called “adenoids” of the throat specialists, while, of still greater interest to the surgeon, the deaths that have occurred from the status lymphaticus have happened repeatedly in operations for these growths within the nasopharynx. Furthermore, the yellow marrow of the bones seems to be replaced by red marrow, but whether this is due to the anemia which always accompanies the condition is not known.
Kaposi some years ago described under the name lymphodermia perniciosa a rare condition characterized by a scaly and itching skin, exuding fluid, with later a diffuse and doughy condition of the affected parts, and then by nodules which sometimes ulcerate, lymph nodes and spleen being also enlarged, and the general health impaired. While some have held that this is a variety of mycosis fungoides, it is supposed that it is only another expression of lymphatism.
Another variety of this condition occurs in young people, in which coma comes on suddenly, followed by death in twelve to eighteen hours. Vomiting may occur during the coma, but it is convulsions and spasm of the glottis that cause the death of the patient.
Thymic asthma has been called laryngismus stridulus. Whether the latter can ever occur without the former is not definitely known, but doubtless the asthma is very frequently the cause of the obstruction and the difficulty in breathing.
Medicolegal questions arise in this connection which are of interest. Death occurs, except under anesthesia, after a series of convulsions, yet it may happen almost instantly. Some claim that death may take place as the result of pressure of an enlarged thymus upon the vessels, and especially upon the nerves, while others claim it to be due to a sudden arrest of heart action by reflex activity.
Convulsions of any character in adolescent individuals and young children should raise a suspicion of this condition, and, of greater importance for the surgeon, all possibility of existence of the condition should be eliminated before operation is undertaken. Deaths occurring during anesthesia are often attributable to the anesthetist; nevertheless there are instances where he is absolutely blameless, and where death may occur as by a flash of lightning.
It does not follow that chloroform is the agent at fault in these cases, and opinion seems to trend in the direction of ascribing the censure to the status itself rather than to the anesthetic used. Deaths may occur at any stage of anesthesia, or some minutes after the anesthetic has been stopped. It is significant that the most conspicuous illustrations of the relations between the condition and sudden death have occurred during operations upon the throat and nose. This seems to show the role played by the adenoid tissue.
Another interesting question is why individuals with well-marked status lymphaticus should live, apparently comfortable for years, and then suddenly succumb from apparently trifling causes.
The relations between the thymus and the thyroid are unmistakable, yet obscure. In perhaps one-half of the cases where the thymus is enlarged the thyroid is also increased in size. When one is removed the other seems to undergo more or less compensatory enlargement. This would seem to indicate a species of interchangeable function. Much less has been ascertained between the relations of either of these bodies and the pituitary, while nothing has as yet appeared concerning any sympathetic involvement of the coccygeal body or Luschka’s gland.