98 ENDOCRINE GLANDS 



The causes are: traumatism, chilling, and particularly, 

 infections; typhoid fever, pneumonia, septicaemia, scarlet 

 fever, diphtheria, erysipelas, influenza, malaria, mumps 

 and acute articular rheumatism. In rheumatism the 

 thyroid is very often affected (H. Vincent). 



The condition starts with a chill, headache, followed by 

 a temperature and pains often very sharp radiating 

 towards the ear, the neck, the shoulders and the back of 

 the head. The patient usually takes the characteristic 

 attitude of the head bent downwards with the chin in the 

 hand. On examination a swelling of the thyroid is noticed 

 together with some local temperature. Very quickly an 

 intense dyspnea develops with attacks of choking, a 

 paroxysmal cough, dysphagia and sometimes a complete 

 aphonia. To these symptoms of compression are asso- 

 ciated signs of hyperthyroidism; tachycardia, tremor, 

 slight exophthalmos. 



The evolution varies. Resolution is the rule in mumps 

 and influenza. Suppuration occurs most frequently after 

 pneumonia, typhoid fever and purpural sepsis. The skin 

 then adheres to the gland, becomes red and edematous, 

 but fluctuation rarely occurs and puncture may be nega- 

 tive due to the depth of the abscess. According to the 

 nature of the causative factor pneumococcus, strepto- 

 coccus or typhoid bacilli are found in the pus. 



Gangrene rarely results, but when it does occur it 

 usually is fatal. 



The differential diagnosis is made between this con- 

 dition and the tumefaction of the gland at puberty and 

 during menstruation, which evolutes without fever; it 

 also must be differentiated from adenitis and abscesses in 

 the neighborhood of the gland and from neoplasms 

 (sarcoma or carcinoma). 





