12 QUATERCENTENARY STUDIES IN PATHOLOGY 



The Spleen.— T\\Q Malpi^hian bodies were much larger than they 

 vshould be, and this increase in size appeared to be due to an augmenta- 

 tion in the number of lymphoid cells surrounding the arterial branches, 

 while the usual structure of the Malpighian body was in other respects 

 retained, and the spleen pulp generally did not shew any change. 

 Possibly this increase in the size of the Malpighian bodies may be 

 similar in its characters to the lymphoid hypertrophy, which occurs in the 

 thymus and other lymph-structures in this disease. 



Case 2. 



Clinical History. — The patient was a female, aged 19, who was first 

 seen at the Aberdeen Royal Infirmary in February, 1904. She presented 

 at that time a typical picture of exophthalmic goitre, the exophthalmos, 

 rapid pulse, muscular tremor, and nervous excitability being particularly 

 well marked. 



Upon the 26th of February the right lobe of the thyroid was removed 

 by Mr. H. M. W. Gray. In order to avoid injury of the recurrent 

 laryngeal nerve, the posterior border of the lobe was shaved off. During 

 the operation, bleeding was somewhat troublesome, and large vessels, 

 both arteries and veins, could be seen running over the surface of the 

 gland below the capsule. The patient made a good recovery from the 

 operation, and in April, 1904, it was noted that her general condition was 

 much improved ; the exophthalmos had almost disappeared, the 

 remaining lobe of the thyroid had much diminished in size, and the 

 general excitability was very much less. The muscular tremors and 

 rapid pulse still remained fairly well marked. 



In January, 1906, she was readmitted to hospital. The general 

 nervous excitability was extreme, the exophthalmos had reappeared, and 

 muscular tremor was very distinct. The rapid pulse had again become 

 pronounced. 



Upon the 2nd of February part of the left lobe of the thyroid was 

 removed. The gland appeared to be somewhat vascular, and bleeding 

 was again rather troublesome. 



Three weeks after this second operation it was noted that the general 

 condition of the patient was very greatly improved. The muscular 

 tremors had gone, the pulse was nearly normal, and the exophthalmos 

 had again disappeared. 



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