THE THYROID BODY. 1789 



In fractures of the ninth, tenth, or eleventh rib the fragments may lacerate the 

 spleen. On account of its great vascularity, wounds of the spleen are serious and 

 often necessitate operation, but occasionally, after small stab wounds or gunshot 

 wounds from bullets of small calibre, spontaneous recovery takes place, and has been 

 attributed (Treves) to the contractility of the muscular tissue of the splenic capsule, 

 which narrows the wound-track, enables it to retain the blood-clot, and thus stops 

 the hemorrhage. 



The blood from a wound of the spleen is usually bright red. In wounds of 

 the liver it is apt to be dark, if the lung is wounded the blood is commonly frothy, 

 and if the stomach has been penetrated the blood is mixed with the acid gastric 

 contents. 



Rupture of the normal spleen is not very frequent, in spite of its friability, on 

 account of the way in which it is suspended from the diaphragm, supported beneath 

 by the elastic colon and — indirectly — the small intestine, and partially protected 

 anteriorly by the stomach and posteriorly by the lung. When it is enl^trged, on the 

 contrary, it extends beyond the region of safety, becomes more closely and exten- 

 sively applied to the parietes, and may b'e ruptured by blows, by falls from a height, 

 or even by muscular violence. Spontaneous rupture can occur only in cases of ad- 

 vanced hypertrophy with softening of the parenchyma. The latter may be ruptured, 

 but the elastic capsule escape. In all these cases of splenic injury the symptoms of 

 localized intra-abdominal lesion, pain, often at first general, then referred to the epi- 

 gastrium or umbilicus, then more marked in the splenic area, sometimes accompanied 

 by nausea or vomiting and followed by rigidity of the left upper quadrant of the 

 abdomen, immobility of the lower thorax on that side, meteorism, etc., plus the 

 symptoms of internal hemorrhage, will be present to a greater or less degree. They 

 have been sufficiently explained in the sections on the intestine, the appendix, and 

 the peritoneum. 



In operations on the spleen it may be approached through incision either at the 

 outer edge of the left rectus muscle or in the median line. 



In splenectomy great care must be taken to avoid premature tearing or division 

 of the large vessels contained within the gastro-splenic omentum and lieno-renal 

 ligament, particularly the splenic vein. The "pedicle" — omentum and vessels — 

 may sometimes best be reached by lifting the inner border of the spleen, and some- 

 times (Warren) by pulling the spleen down from beneath the diaphragm and turning 

 it completely over. 



Next to hemorrhage, the chief risk is that arising from damage to adjoining 

 viscera during the separation of adhesions, and the relations of the stomach, pan- 

 creas, colon, and kidney should therefore be carefully borne in mind. 



THE THYROID BODY. 



This organ is situated in the neck in front and at the sides of the trachea. It 

 is symmetrical in plan, but not usually in the details, consisting of two lateral lobes 

 connected by a narrow strip, the isthmus, from 5 mm. to 2 cm. in breadth. The 

 height of the lateral lobes ranges from 3 cm. , or less, to twice as much within normal 

 limits. The transverse diameter of the whole organ is 6 or 7 cm. The weight is 

 from 30-40 gm. (i-ii/4 oz. ), with wide variations. It has the appearance of a 

 lobulated glandular body, reddish yellow in color. 



Shape and Relations. — Each lateral lobe is an irregular body, vaguely 

 pyramidal in form, which can be properly studied only i?i situ. There is an a?itero- 

 external surface which meets the inner at a sharp border. The inner surface is con- 

 cave, being moulded over the side of the trachea and larynx. These surfaces are 

 connected by a third, \}i\^ posterior surf ace (usually improperly called a border), which 

 faces backward and outward, sometimes nearly backward. The surfaces come to- 

 gether above in an apex over the posterior part of the body, so that the border sepa- 

 rating the antero-external and the internal surfaces rises from the middle of the body 

 obliquely backward. The lower end of the lateral lobe is thick and rounded. The 

 isthmus, connecting the lateral lobes below the middle, usually crosses the second and 

 third rings of the trachea. Its anterior surface passes without interruption into the 



