14 QUATERCENTENARY STUDIES IN PATHOLOGY 



fragments was of a pink or yellowish-pink colour, and presented a some- 

 what mottled appearance. 



Upon microscopic examination the sections presented the same 

 patchy appearance as was seen at the examination of the specimen 

 removed at the first operation, but the areas of large alveoli now pre- 

 dominated. In many instances these large alveoli were of quite regular 

 shape, and were filled with colloid, which stained homogeneously, and 

 was of normal appearance. Their epithelium had a distinct tendency to 

 revert to the normal cubical type, while the epithelium of the smaller 

 alveoli still retained its high columnar arrangement. These small 

 alveoli, however, undoubtedly contained more colloid than previously, 

 although it still remained granular or vacuolated. Probably the most 

 striking microscopic feature was the large amount of lymphoid tissue. 

 Every section shewed numbers of rounded or oval lymphocyte deposits, 

 many of them of considerable size. Occasionally one of the gland 

 alveoli appeared to have become enveloped by the larger lymph depots, 

 and to have undergone atrophy in consequence. Plasma cells were 

 particularly numerous. Each of the lymph deposits contained several of 

 them ; indeed, long rows and columns of these cells could be traced 

 between the smaller alveoli, and in parts formed quite extensive deposits. 

 They appeared to follow the course of the capillaries and small blood 

 vessels, and to accumulate around their walls. 



Case 3. 



M. W., a female school teacher, aged 41 years, had suffered from 

 symptoms of Graves' disease for three years. Upon examination she 

 shewed well marked thyroid tumour, distinct exophthalmos, rapid pulse, 

 loss of flesh, and very evident muscular tremors. She complained 

 greatly of this last symptom, and of nervous excitability and palpitation. 

 The right lobe of the thyroid was distinctly more enlarged than the left. 



On July 4th, 1903, Mr. Gray removed the right lobe of the thyroid 

 by an operation exactly similar to that adopted in the last case. 

 Haemorrhage was comparatively slight, and easily controlled. She stood 

 the operation well, and made a rapid recovery. Very great improvement 

 in her condition resulted. Tremor almost disappeared, the exophthalmos 

 rapidly lessened, the pulse rate fell, and the enlargement of the left lobe 



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