THE SYMPATHETIC SYSTEM 99 



The treatment consists in the application of warm 

 compresses and leeches. Tracheotomy may be indicated 

 in the cases of dyspnea and suffocation. Surgical inter- 

 vention has to be resorted to in suppurative or gangrenous 

 thyroiditis. 



* * 



TUBERCULOSIS or THE THYROID is rare. For a long 

 time is was believed that the thyroid tissue had a peculiar 

 resistance to tubercle bacilli; as a matter of fact, like all 

 vascular organs, it does not offer a favorable field to the 

 development of the tubercle bacillus and the formation 

 of tuberculous lesions. 



1. MILIARY TUBERCULOSIS. Is the best known and 

 most common type. It has no particular clinical interest 

 and is usually found at autopsy as a secondary manifesta- 

 tion of tuberculosis. 



2. MASSIVE TUBERCULOSIS of the thyroid is rare. 

 It can be found in two different types of cases. 



(a) Tuberculous goitre, which gives rise to a hard 

 thyroid tumor, which causes respiratory disturbances by 

 pressure and which sometimes simulates thyroid goitre, 

 because of the rapidity of its growth, so much so that the 

 extirpation of the gland may be necessary. This form 

 causes caseation: the gland is studded with large solitary 

 tubercles fresh or broken down. 



(6) Cold abscess of the thyroid sometimes resembles a 

 cystic goitre and may cause dysphagia, compress the 

 larynx or the recurrent laryngeal nerve or the sympathetic. 

 The patient can recover after incision and drainage. 



3. SCLEROUS TUBERCULOSIS OF THE THYROID is 

 found quite often in chronic tuberculosis (Roger and Gar- 

 nier). The thyroid is atrophic, decreased in size and 

 paler than normal. The connective tissue is considerably 



