SOME CASES OF GOITRE 259 



lumen of the thyro-glossal duct into the cavity of the 

 thyroid gland? A truly wonderful series of connected 

 vascular disposals, a stoppage of or interference with 

 which, as here, may have far-reaching consequences, 

 physiological, pathological, and clinical, if true \ 



The very frequent occurrence of enlargement of the 

 cervical glands seems also to be possibly related to the 

 local wandering of pituitary material beyond its usual exit 

 mechanism and vasculature, and its lymphatic absorption 

 and passage into the nearest lymphatic glands, which here 

 are the cervical ; moreover, the enlargement of the glands 

 usually begins with the most superior, which corresponds 

 with anatomical and histological necessities, and progresses 

 downwards from gland to gland, the matter accumulating, 

 and undergoing caseation, before its relief by necrosis 

 of super-imposed textures, and breaking down of the 

 accumulated mass. Besides the anatomical conditions 

 being satisfied, the characteristics of the gland ballooning 

 material conform to those of an inspissated pituitary 

 excretion, and warrant us in claiming for its etiology, in 

 such cases, a real existence of cause and effect in their 

 development and sequence the performance by the glands 

 of an unwonted physiological function leading to the 

 development of a pathological condition. 



Besides rendering possible the occurrence of such disease 

 as goitre, the occasional occurrence of patency of the thyro- 

 glossal duct also lends possibility, nay, probability, to the 

 conclusion that the physiological disposal of cerebral 

 residual matter is part of the function of the thyroid 

 gland, and, if so, that we have here afforded a clue to the 

 explanation of many very obscure symptoms and diseased 

 conditions, whose only connection with each other is that 

 they are in some way related to pathological conditions 

 of that gland, and themselves lead to or flow out of that 

 relationship. Thus, cretinism is associated with absence 

 or atrophy of the thyroid gland, and, consequent, local 

 and general wandering of brain waste, with implied 

 hindrance of physiological or normal developmental 

 changes, and the appearance of other related characteristic 

 and specific developmental aberrations. Myxoedema^ like- 

 wise, asserts itself in association with non-effective thyroid 



