THYROID GLAND. 



1115 



veniretur. Hie enim steatoma, ibi atheroma, 

 alio in loco purulcntus tumor, in alio hyda- 

 trius, in alio erat coagulatus sanguis, flnidus 

 fere in aiio, imo hinc glutine loculus plenus 

 erat, alibi calce cum sebo mista." 



I may mention here tbe results of micro- 

 scopic examination of a specimen of this form 

 of enlarged thyroid, for the opportunity of 

 making which I am indebted to the kind- 

 ness of the medical officers of St. George's 

 Hospital. The gland was greatly enlarged ; 

 its surface somewhat nodulated. A sec- 

 tion displayed a number of cavities visible to 

 the naked eye, some of which were circular, 

 others elongated, and as it were compressed. 

 Many of them were about the size of a large 

 pin's head; some however, much more capa- 

 cious. The majority were filled with a slightly 

 opaque, firm, gelatinous material ; but some 

 (the larger) with cretaceous or ossiforrn matter, 

 and some also with a reddish material. The 

 intervening structure in several places appeared 

 tolerably natural ; but even in this, on close in- 

 spection, enlarged vesicles were perceptible. 

 The areolar tissue separating the lobes of the 

 gland was hypertrophied, and formed whitish 

 septal bands. Under the microscope it was 

 seen that the vesicles were generally enlarged. 

 They were found of all sizes, from those that 

 were distinctly visible to the naked eye, or still 

 larger, down to the natural size. Their walls 

 were somewhat but not uniformly or very 

 greatly thickened. The homogeneous envelopes 

 presented, generally, somewhat of a fibrous 

 appearance. The greater number of the 

 cavities were distended with a transparent, 

 feebly refracting, structureless, material, in 

 which were numerous small irregularly shaped 

 particles of higher refracting power. This 

 material resembled, almost exactly, the normal 

 secretion in appearance, and, like it, was free 

 in the cavity of the vesicles. In these vesicles 

 there was very little trace of epithelium, only 

 some small, and few, non-nucleated corpuscles ; 

 but in other vesicles the epithelium was so 

 abundant, that it completely occupied the 

 cavity. It was in no respect different, except as 

 to quantity, from its healthy condition, con- 

 sisting of mere nuclei and interposed granular 

 matter in no great abundance. In some of 

 the vesicles there were large and beautiful 

 crystals of more or less perfect octohedrai form. 

 These were either oxalate of lime or triple 

 phosphate. One prodigiously enlarged vesi- 

 cle contained a mass of calcareous matter, 

 very firm and dense throughout, but most in 

 its central and peripheral parts. In the latter 

 situation there were numerous masses of ossi- 

 form substance, of yellowish semi-transparent 

 aspect. On crushing these, no bone lacunse 

 could be discerned in the fragments. They dis- 

 solved freely with strong effervescence in 

 nitric acid, leaving an homogeneo-fibrous basis 

 substance, which often exhibited a greenish 

 yellow tint. The material, thus proved to be of 

 cretaceous nature, contained, mingled with it, 

 numerous tablets of cholesterine. One small 

 reddish mass, occupying the cavity of a vesicle, 

 was found to consist almost wholly of blood 



globules and their detritus, and thus seemed 

 to be the result of haemorrhage. Another 

 opaque whitish mass did not effervesce with 

 nitric acid, and was therefore not cretaceous ; 

 it consisted of epithelial nuclei mingled with 

 peculiar, and rather abundant, granular matter. 

 In the above account it is worth noticing that 

 no cells were found ; the epithelium retained its 

 natural appearance ; also the matter distend- 

 ing the greater number of the cavities resem- 

 bled exactly, so far as the eye could judge, the 

 natural secretion ; and lastly, that in some in- 

 stances there was an accumulation of unaltered 

 epithelium and not of the secretion. This 

 last fact is of some importance with respect 

 to the exact nature of the function discharged 

 by the epithelium. 



Owing to the kindness of my friend, Mr. 

 H. Gray, 1 have recently had the opportunity 

 of examining a remarkable specimen of Bron- 

 chocele. The gland was greatly enlarged, to 

 five or six times its natural magnitude, and 

 altered in form, one lateral lobe being raised 

 up higher than the other, and the surface 

 being somewhat uneven and nodulated. On 

 a section being made, the exposed surface 

 presented a reddish glossy aspect, somewhat 

 resembling that of certain forms of malignant 

 disease which are undergoing softening : there 

 was no appearance of distended cavities ; in 

 fact, the structure to the eye exhibited less of 

 the cellular arrangement than is usual. Micro- 

 scopic examination confirmed the impression 

 derived from simple inspection. But little of 

 the natural secreting structure remained, the 

 vesicles being destroyed, and their secretion, 

 though still present in some quantity, being 

 certainly diminished. Some traces of the 

 epithelium of the cavities were perceptible; 

 but there was no special cell growth indicative 

 of any adventitious formation ; a few large 

 cells or globules only, varying in size from 

 ^- to -^-^ in. diameter, existed in some 

 of the remaining cavities : these evidently 

 consisted of aggregations of oily molecules 

 and drops not manifestly enclosed by any en- 

 velope. The blood-vessels were prodigiously 

 and universally enlarged ; some of those which 

 were capillaries in structure were from two to 

 three times their normal diameter, and irre- 

 gularly dilated and varicose; they were every 

 where clustered over with minute oil drops ; 

 which formed so thick a coating to many of 

 them, that they appeared as white cylinders 

 by direct light. Some parts of the gland pre- 

 sented to the naked eye a whiter aspect than 

 others ; and in them it was seen that the de- 

 posit of oily matter along the vessels, and the 

 destruction" of the glandular tissue, had pro- 

 ceeded to the greatest extent. In some places 

 there were masses of ossiform deposit. 



The morbid alteration now described ap- 

 proaches most nearly, I think, to the vascular 

 and aneurismatic bronchocele ; but the exten- 

 sive destruction of the glandular tissue, and 

 the copious deposit of oily matter, show that 

 there must have been some grave derangement 

 of the nutrition of the gland. The case oc- 

 curred in a female (aet. 75.), who died with 



