122 THE DISEASES OF THE THYROID GLAND 



thyroids were present, which could not, however, fully compensate the 

 deficiency. Pineles then cites seven works of a more recent date in which an 

 exact microscopical examination failed to find any remnants of thyroid gland 

 (Kocher-Langhans, Muratov, Maresch, Peucker, Aschoff, Erdheim, Knopfel- 

 macher). The case of Maresch was that of an eleven-year-old girl whose 

 brothers and sisters were perfectly well; according to the statements of the 

 parents, growth ceased almost entirely at one and a half years of age. At 

 eleven years of age, the girl was 77 cm. tall, the skull had a circumference of 

 49 cm., the abdomen 53 cm., the great fontanelle measured 4^ cm. by 

 \}^, cm. The girl could not walk, could only sit, and could speak only a few 

 syllables. The skin was myxedematous (also on microscopical examination) , 

 the hypophysis was of normal size, the thymus gland corresponded with the 

 age. Pancreas and suprarenals were of normal size. 



The contribution of Maresch was of fundamental importance, because 

 Maresch established for the first time in his case the presence of the parathy- 

 roid glands. Also later investigators found the parathyroid glands intact. 

 Only in a few cases was the simultaneous absence of parathyroid glands re- 

 ported (Quincke, Case I, Rocazet Cruchet, two cases of Siegert). Here, how- 

 ever, no serial sections were made. 



Very exactly studied are the cases of Aschoff, of Erdheim, and of Dieterle. 



The case of Aschoff was that of a half-year-old child of 53 cm. length. 

 The hypophysis was very much enlarged (o. 5 gm.) . A schoff found at the root 

 of the tongue a cystic tumor that he regarded as the remnant of the lingual 

 duct. In addition, there was found at the site of the lateral thyroid lobe a 

 half-pea-sized vesicle that he regarded as the remnant of the branchial pouch. 

 The case of Erdheim was a thirteen-month-old child, the thirteenth child of 

 healthy parents. High-grade constipation had been present (palpable fecal 

 tumor). Here also was found the vesicle as in the case of Aschoff; micro- 

 scopical examination showed that it consisted of an ectodermal formation, 

 as to the origin of which from the fourth branchial pouch there could be no 

 question, as Erdheim found the same cysts on this side in two cases of 

 unilateral thyroaplasia, in which cysts on the normal side were absent. 



Very recently have been added the cases of Ungermann (vicarious tongue- 

 struma), MacCallum and Fabyan (cysts in the neighborhood of the superior 

 parathyroids), and finally three cases of Schilder. In all cases exactly in- 

 vestigated up to the present these cysts have been found at the site of the 

 lateral lobe of the thyroid. Dieterle could demonstrate in his case the 

 absence of the rudiments of the superior thyroid arteries. 



We are therefore justified in the assumption that in these cases an anomaly 

 of formation is present that consists in an agenesis of the lateral rudiments 

 of the thyroid. The vesicles found at their site consist in indifferent rests 

 of the postbranchial bodies, in which under circumstances isolated thyroid 

 follicles may be imbedded. At the root of the tongue are found, at the site 



