engorge the chest vessels with blood and in addition seem to congest the thymus. The congenitally enlarged thymus and even the acquired hypertrophied thymus respond readily to X-ray treatment. Altho this effect is primarily one upon the lymphocytic elements, there also seems to be a certain effect upon the reticular ele ments. One of the facts that has to be taken into consideration is the partial degeneration of the cortex of the adrenal glands which occurs in the first few weeks of life, a degeneration which undoubtedly acts as a stimulus to the thymus, as all evidence is consistent that the adrenal cortex and the thymus are antagonists. It may consequently happen that an apparently wellborn child will develop during the first few weeks of its existence, or soon after then, the condition called "thymus asthma." The thymus asthma attack occurs suddenly. Acutely, the baby has difficulty in taking in air, inspiratory stridor, a peculiar crowing sound. A depression occurs above the sternum as it inspires. And when it endeavors to expel air, a mass appears pushed out above the breast bone. This tumor is the upper end of the thymus. Death by suffocation may occur in the first attack or there may be repeated attacks. By removal of the thymus, or by sewing it against the breast bone to prevent its upward movement, or by X-ray or radium. treatment, the attacks may be prevented. Mechanical thymic asthma must be distinguished from other cases of thymus death in which the heart stopped before the breathing ceased, accurate descriptions 8. HART, C.: Virchows Archiv. f. path. Anat. u. Physiol., 1912, Bd. 207; Bd. 210, Heft 2; 1913, 214, I; 1914, 217; 1917, 224; Med. Klinik, 1913, 9, 1466, 1507; Wien klin. Wchnschr., s. 1119, 1908; Munchen. med. Wchnschr., 1908, 55; Centralb. f. d. Grenzgeb. f. Med. u. Chir., 1909, Bd. 12; Arch. f. klin. Chir., 104; Medizinsche Wchnschr, 1908, s. 668. u. 744. Jahrbuch f. Kinderh., 1917, 84; Die Lehre vom Status Lymphaticus; J. F. Bergman, 1923. 10. JACKSON, C. M.: Am. Jour. Anat., 1915; Jour. Exper. Zool., 1915, 19. 11. JOLLY, J. and LEWIN, S.: Compt. rend. Soc. d. biol., 1911, 71, No. 70. 12. MAXIMOw, A.: Verhandl. Anat. Gesellsch., Berlin, 1908; Folio. haemat. Jahrg., 4, 1907; 1909, Bd. 8; Ztschr. f. Wissensch. Mikrl., 1909, Bd. 26; Arch. f. mikrosk. Anat., 1909, Bd. 73; 1909, Bd. 74; 1911, Bd. 79; Bd. 80, H. I. Abt. I. 13. POTT: Jahrb. f. Kinderheik., Leipzig, 1892, 34. 14. STEWART, L. F.: Proc. Med. Soc. of Penn., September, 1916. 15. WALDEYER, W.: Verhandl. X. Intermat. med. Kongr., Berlin, 1890, Bd. 2; 1891, Bd. 2, Abt. I. Who brings sunshine into the life of another has sunshine in his own.-David Starr Jordan. Hodgkin's lymphoma, lymphosarcoma, and the leukemias constitute an interesting group of conditions which are characterized by symptoms, physical signs, and laboratory evidences, due to pathology in the blood and lymph glandular systems. Clinical observations and a study of the pathologic reports in these conditions have impressed me with the view taken by other observers (Mueller, Yamasaki, Karsner, and Welch) that they are all due to the same underlying pathology, and that each is but another phase of the same process. I have seen cases admitted to the hospital with physical and laboratory evidences of Hodgkin's lymphoma, which later in the course of the disease, show by biopsy to be lymphosarcoma. Similarly, I have seen a patient with clinical symptoms and pathologic report of lymphosarcoma, terminate with a blood picture of leukemia. Analogous to the types of carcinoma, such as squamous cell and transitional cell types, each showing differences in degree of response to radiation, there probably exists a group of malignant conditions of the blood and lymph glandular systems presenting different types, depending upon the predominance of cells present. In general, patients with Hodgkin's lymphoma, lymphosarcoma, or leukemia, present sufficient clinical manifestations to diagnose or suspect the presence of the conditions. However, there is a group of patients which present symptoms almost entirely referable to the nervous system, and a diagnosis is made of a neurologic con 1 dition. The subsequent clinical course or autopsy findings show the pathology of Hodgkin's lymphoma or lymphosarcoma. It is not uncommon to see a diagnosis made of spinal cord tumor, which at autopsy may show diffuse infiltration of the spinal cord with malignant lymphoma. I have seen a case recently in which on account of progressive dysphagia and loss in weight a gastrostomy was performed and examination showed a pathologic report of Hodgkin's lymphoma. It is, therefore, important to remember the possibility of the presence of Hodgkin's lymphoma or lymphosarcoma with clinical signs and symptoms entirely neurologic. Surgical procedure in such cases is entirely useless, while radiation has produced marked improvement in some of these cases. The prognosis in these conditions, as far as cure is concerned, is hopeless. Medical and surgical therapy are not very encouraging. Radiation therapy is the only method of definite value in producing regression, alleviation of symptoms, and prolongation of life for several months or years. Such cases under proper hygienic, tonic, and radiation therapy, with continued clinical observation, can be made fairly comfortable, and even controlled sufficiently to allow the patient to be up and about, and to attend to light duties. The response to radiation is most marked and occurs earlier in lymphosarcoma than in Hodgkin's lymphoma. In the former, there is usually evidence of regression 1 Presented before meeting of Alumni Society of Lebanon Hospital May 8, 1928. FIG. 1. Roentgenogram of Chest, July 6, 1926. Before treatment. white blood cells will be markedly reduced and sometimes the lymphatic glands return to normal size. In obscure cases, where the diagnosis is uncertain, a careful history of the clinica! course and interpretation of the physical signs may be of more value than a biopsy, respond to Roentgen-ray therapy there occasionally occurs a case which proves to be resistant to Roentgen therapy, but will show sensitiveness to radium therapy. Case M. H., female, age 45, married, consulted me September 11, 1926, with the following history: Family history: Negative. FIG. 2. Roentgenogram of Chest, October 15, 1926. After Roentgen Therapy-shows diminution in pathology. over this area. Purplish discoloration of skin over sternum, non-productive cough, dyspnea, progressive weakness, some weight loss, and pain in the mediastinum radiating to left shoulder and down left arm. Examination by me showed the following positive findings: Eyes: Moderate exophthalmus. Chest: On inspection showed the sternum. fairly prominent with bluish discoloration 6,000; P. 68 per cent.; S. L. 15 per cent; L. L. 8 per cent.; Trans. 1 per cent.; Mono. 4 per cent.; Eosino. 4 per cent. Blood Wassermann and blood chemistry negative. I made a diagnosis of mediastinal neoplasm (lymphosarcoma), and referred her to her physician, with my findings. He was satisfied with my diagnosis and sent her back to me for therapy. The patient then |