Status Thymico-Lymphaticus

STATUS THYMICO-LYMPHATICUS (thymico-lymphatic state), a constitutional type advanced by Paltauf in 1889. It is characterized by a pale complexion, well-developed subcutaneous fat, an enlarged lymphatic apparatus of the nasal pharynx and the root of the tongue, and an enlarged or underdeveloped thyroid gland, often accompanied by a narrow aorta. In biological terms, such individuals are poorly resistant and often die from insignificant endogenous and exogenous factors. The enlarged lymphatic apparatus and thyroid gland are morphological signs characterizing a disturbance of metabolism, which lies at the basis of this constitutional anomaly. Autopsies of such subjects do not provide sufficient data on the cause of death, and the latter can be explained only by the special lability inherent in the lymphatic constitution, with the characteristic "heart death" for it. Historically, S. th.-l. has its origins, on the one hand, in the doctrine of thymic death (mors thymica), first substantiated by Plater (F. Plater, 1814), and on the other, in the doctrine of the Vienna school on lymphatic constitution by Rokitansky and Virchow's doctrine on lymphatic-chlorotic constitution with a narrow aorta. Subsequently, the original Paltauf type underwent significant expansion under the influence of new concepts of constitutional types and the progress of endocrinology. Later, in S. th.-l., hypoplasia of the chromaffin system (Wiesel), atrophy of the adrenal cortex (Vejpek), and hypoplasia of the gonads (Wiesel and others) were found. The superimposition of new anatomical signs, especially signs of a hypoplastic nature, such as hypoplasia of the gonads often accompanied by eunuchoidism and infantilism, hypoplasia of the chromaffin system, and aortic stenosis, led to the fact that S. th.-l. was often considered or identified with status hypoplasticus (Bartel) and status degenerativus (Bauer). According to Bartel and Stein (Wagel, Stein), two forms of lymphatism should be distinguished: lymphatism as a reaction to various injuries, infections, intoxications, and lymphatism caused by the proliferation of lymphoid tissue in connection with a constitutional anomaly. The latter form is characterized by its combination with a large thyroid gland and the early onset of cirrhotic processes in the lymph glands, depending on the premature wear of the lymphoid tissue. In S. th.-l., proliferation of connective tissue is observed not only in the lymph glands but also in other organs: in the ovaries and testes (Kyrle), in the walls of arteries in people with a hypoplastic constitution (Wiesel), and in the chromaffin system; all this indicates a fibroplastic diathesis lying at the basis of S. th.-l. In it, there is primary, constantly progressive proliferation of connective tissue, which secondarily leads to the death of glandular tissue of various organs and systems. In reality, it is difficult to distinguish between primary and secondary fibrosis, and very little evidence has been presented in favor of this theory to this day. But in any case, a bridge was thrown between Bartel's connective tissue diathesis and the fibroplastic diathesis of French authors, on the one hand, and S. th.-l., on the other. S. th.-l. is a congenital condition and can be inherited. S. th.-l. is already detected in newborns in the form of a large thyroid gland with simultaneous excessive development of lymphatic tissue (Schridde). In S. th.-l., death can occur suddenly in full health, while bathing, during mental excitement, from chloroform, ether anesthesia, local anesthesia, etc. Subjects with S. th.-l. suffer from infections more severely; toxic forms of diphtheria and pneumonia occur more often in them, and they have less resistance to typhoid infections and influenza. S. th.-l. is often found among suicides. In those killed in war, a thymico-lymphatic state was frequently found. This was explained by the fact that they die more easily from trauma, gas, etc. Autopsies of persons killed on the battlefield raised doubts about the existence of the S. th.-l. type. The frequency of detection of S. th.-l. in persons killed in war naturally gave rise to the thought whether a well-developed thyroid gland and well-expressed lymphatic tissue are signs of a young healthy organism (Groll). Studies by a number of authors (Nachtag, Lowenthal, Jaffe, Morgenstern) confirmed Groll's findings, and at present his view is generally accepted. The error in the doctrine on S. th.-l. consisted in the fact that pathological findings regarding the thyroid gland and lymphatic tissue on hospital autopsy material were taken as normal, and the latter as a normal phenomenon. The observed cases of hyperplasia of lymphoid tissue are predominantly of a regional character, depending on local factors, and should be correctly regarded as secondary regional hyperplasias, and not as partial S. th.-l.

3. Morgenstern.