1114 



THYROID GLAND. 



attained, if the origin of the vessels had been 

 below instead of above the point of giving off 

 of the arteries to the brain. Besides, however, 

 this argument, two others may be mentioned 

 which at least favour the same view. One is, 

 that no special characteristic principle appears 

 to exist in the secretion of the thyroid, but 

 that it is a mere modification of albuminous 

 matter, this seeming to imply that no special 

 use is served by the secretion of the gland, 

 that it is not elaborated for the sake of pro- 

 ducing any peculiar effect on some other part, 

 but that it is simply secerned from the circu- 

 lating current for a time, to return and mingle 

 with it again in a condition but little altered 

 from its primitive one of blood-plasma. The 

 other argument is drawn from the con- 

 dition of the epithelium, which, as we have 

 before remarked, seems adapted for rapid and 

 transitory action, so that it might quickly 

 secrete a large amount of material on any 

 diminution of the nutrient processes in the 

 brain. These arguments may be allowed to 

 possess some weight. Before, however, this 

 theory can be regarded as at all established, 

 a more sure and discriminating chemistry must 

 prove some relation of composition to exist 

 between the secretion of the thyroid and the 

 grey nervous matter. Till this is done we can 

 but deal with the question afar off, without 

 bringing it to an exact issue. 



MORBID ANATOMY. The following morbid 

 changes have been observed to occur in the 

 thyroid ; ( 1 ) It may be affected with com- 

 mon inflammation. (2) It may be variously 

 altered by unhealthy or perverted action of its 

 own glandular structure. (3) It may be the 

 seat of adventitious formations. (4) Its 

 vessels may become remarkably enlarged, as 

 in the so calleo^ aneurism by anastomosis. 



Inflammation. Professor Hasse gives the 

 following description of inflammation occur- 

 ring in the thyroid. " It is rare, but may at- 

 tack the organ either when healthy, or when 

 enlarged by previous disease. Its course is 

 more frequently chronic than acute. Within 

 a very brief interval the gland often swells 

 considerably, becomes very bloodshot, tense, 

 and painful, its texture softened and friable, 

 assuming at first a brown red, and ultimately 

 a dingy gray colour. The morbid anatomy 

 of this grade of inflammation is but imper- 

 fectly known ; that of the suppurative stage 

 has been more frequently observed, and 

 more fully described. Either separate ab- 

 scesses form, or else the entire gland is 

 converted into pus. Under favourable cir- 

 cumstances the abscess opens externally 

 through the skin. There are, however, ex- 

 amples of its obtaining vent through the 

 ossophagus, and determining a protracted 

 fistula of the gullet,* or of its discharging 

 itself into the trachea, and producing death by 

 suffocation.-)- After evacuation of the pus, 

 together with numerous shreds of dead cellular 

 tissue, the tumour collapses ; the gland on the 



* Unger, Beitrage zur Klinik der Chirurg. vol. i. 

 t Meckel. 



side affected shrivels into a hard, cellulo- 

 filamentous knot, which adheres firmly to the 

 skin and to the surrounding parts. Some- 

 times the shrivelling of the one ^gradually 

 brings on wasting of the other lobe." 



Alterations of Structure. Under the se- 

 cond head may be included hypertrophy of 

 the thyroid, or some enlargement without 

 appreciable change of texture. " This variety," 

 Prof. Hasse states, " is frequent, and for 

 the most part inconsiderable." It probably 

 depends merely on distension of the glan- 

 dular cavities by their accumulated secre- 

 tion. This change is almost wholly " confined 

 to youth, and is frequent about the age of 

 puberty in both sexes, more so, however, in 

 the female." " Alternatives of increase and 

 decrease are especially apparent in this kind 

 of bronchocele, enlargement being most con- 

 spicuous at the approach of the menstrual 

 period." This form, though it may be called 

 hypertrophy, is not quite strictly so desig- 

 nated, as there is no formation of new glandu- 

 lar tissue, but only distension of the original 

 cavities, by an increased quantity of secretion. 



" Melicenms degeneration of the thyroid is 

 one of the most frequent forms. It occurs at 

 all ages, and is uniformly attended with intu- 

 mescence. It may involve the organ in whole 

 or in part. In the former case the component 

 granules (or vesicles) are found unusually and 

 unequally enlarged, and transformed into sepa- 

 rate cells filled with a tenacious, viscous, jelly- 

 like substance, of the colour of honey. The 

 entire part is hard, nearly bloodless, and but 

 loosely coherent with the surrounding parts. 

 Where, as frequently happens, only certain 

 portions are disorganized, these form spherical 

 tumours varying in size, and imbedded clearly 

 in the healthy structure. They present a 

 brownish or yellow colour, and the consistency 

 of jelly or of melted glue. Sometimes they 

 appear as an opaque, reddish, soft, or even 

 lardaceous, swelling. In general but few 

 blood vessels are visible in this goitre, although 

 it may now and then be associated with ex- 

 uberant vascular growth." 



The foregoing description is quoted from 

 the translation by the Sydenham Society of 

 Professor Basse's work. He does not, how- 

 ever, seem to notice sufficiently, under this 

 head, the variety of matters which are found 

 in the enlarged glandular cavities. Cretaceous 

 matter, either in a pulverulent state, or form- 

 ing hard ossiform Amasses, I believe often 

 occurs, and in Prep. 1498, of the Patholo- 

 gical collection in the Museum of the College 

 of Surgeons, there is seen a quantity of solid 

 white substance, either opaque and soft, or 

 transparent, firm and chondroid, which oc- 

 cupies the larger cavities, the majority being 

 filled with a transparent jelly-like material ; 

 some also with cretaceous matter. One in- 

 teresting instance, probably belonging to this 

 class, is quoted in the Cyclop, of Pract. Medi- 

 cine from De Haen : " In cadavere horren- 

 dam mole thyroideam nactus, publice dissecui. 

 Mecum auditores mirabantur, nullum fere genus 

 tumorurn dari, quin in hac sola thyroidea in- 



