SOME CASES OF GOITRE 257 



dition to material either going to or returning from the 

 thyroid isthmus, and latterly, when the evolution of the 

 entire thyroid gland had been effected, the entire gland. 

 That being so, what more reasonable and likely could we 

 suggest than that an unusual post-natal patency of the 

 thyro-glossal duct, either as a survival from pre-natal times 

 or the product of causes conducive to the revival of its 

 dormant, pristine, ante-natal patency and conducting 

 powers, allowed of, or lead to, its original functional role 

 being re-taken up. 



These possibilities, and the fact that cystic tumours 

 and local balloonings of its lumen take place post-natally 

 from time to time, render the further possibility, nay proba- 

 bility, of the occurrence of the invasion of the central 

 inter-spaces of the gland a most likely and, in fact, an 

 actual occurrence. The natural, and perhaps sometimes 

 exaggerated, endothelial secretion and resultant material 

 debris might, in the event of the renewed patency of the 

 duct, be sufficient to produce ballooning of the gland, but, 

 if not, we have not far to seek for the requisite material 

 for its accomplishment if we but turn to that pituitary 

 dumping-ground situated "all round" the upper extremity 

 of the lumen of the duct, where it originates in the before- 

 mentioned foramen caecum, into which or where the 

 V-shaped sulcus or gutter terminates or dips. This 

 abundant supply has only to be tapped in order that an 

 unfailing stream of the required ballooning material should 

 inundate the yielding textures of the thyroid gland, and 

 produce the disease known as goitre ; therefore, we may 

 take it, cum grano salis, that this may frequently be the 

 "state of things," and, hence, that we must look "for a 

 way out of the situation" by a careful survey of these 

 local conditions, which may haply yield practical indications 

 for the direction of both the art and science to be involved. 



A renewal of the activities of the duct, an attenuated 

 condition of its re-developed walls, and the presence around 

 these walls of a plastic but circulatable material, which 

 only waits to feel the "line of least resistance," constitute 

 the essential conditions on which the causation and evolu- 

 tion of this disease in such cases at least are likely to 

 depend, and offer a rational solution of a very enigmatous, 



