l6 QtJATEkCEt^TENARV STUdIES l^ PAtHOLOGV 



small alveoli frequently contained only a small quantity of granular 

 material, which stained somewhat deeply with eosin, and bore no 

 resemblance to ordinary colloid ; in other instances they contained a 

 small amount of granular and vacuolated colloid. The colloid of the 

 large alveoli was invariably vacuolated, and stained in a patchy manner ; 

 leucocytes and desquamated cells were frequently seen within it. The 

 sections always shewed numerous lymph-deposits, in character alike with 

 those described under Case i. None of the thyroids exhibited any 

 tendency to interstitial fibrotic change, and there was no evidence in 

 support of the theory that the blood vessels played any part in the 

 formation of the goitre. 



The general appearances in all three instances were strongly 

 suggestive of increased activity of the gland ; the colloid secretion being, 

 moreover, of abnormal character. They were in accord in most respects 

 with the published descriptions of the changes of the gland in the 

 disease. 



Case I would seem to shew that, in this instance, at least, the disease 

 was of thyroidal origin. There was a complete absence of any of the 

 changes which have been described as occurring in the central nervous 

 and sympathetic systems. 



With regard to Case 2, the microscopic appearances of the second 

 portion of the gland removed seemed to indicate some attempt upon 

 the part of the thyroid tissue to revert to its normal condition as a result 

 of the first operation. Certain of the alveoli were undoubtedly larger 

 and of more regular shape than those seen on section of the first 

 specimen from this case. The colloid contained in these was practically 

 of normal character, and the lining epithelium approached very closely 

 in some of them to the normal cubical type. 



In conclusion, I must express my indebtedness to Dr. George 

 Edmond for the opportunity he afforded me of making the post mortem 

 examination of Case I ; and to Mr. H. M. W. Gray for permission to use 

 the clinical histories of Cases 2 and 3. 



(214) 



