1116 



THYROID GLAND. 



cirrhosis of the liver and ascites ; the kidneys 

 contained numerous small cysts, and there 

 were two fibrinous blocks in the spleen. 



Adventitious formations. Cystic formation 

 within the thyroid is next described by Pro- 

 fessor Hasse ; and regarding it as depending 

 on the development of new cysts within 

 the gland, and not on the perverted or ex- 

 cessive action of its own natural vesicular 

 cavities, it will fall under our third head. 

 I am, however, rather in doubt whether 

 most cases of cystic formation in the thy- 

 roid do not belong to the second category, 

 and are not dependent on the development 

 of any adventitious structure. Prof. Hasse 

 says, " cystic formation within the thyroid 

 gland is one of the most frequent causes of 

 goitre. It occurs both by itself, and in con- 

 junction with other kinds of degeneration, 

 and constitutes the largest and most unsightly 

 of all tumours. Cysts of every variety and 

 size, either solitary or in congeries, are en- 

 countered in every* part of the thyroid gland ; 

 an entire lobe, nay, the greater portion of the 

 whole organ, being sometimes engaged in 

 cystic development. The surrounding tex- 

 ture is seldom healthy, being generally com- 

 pressed, flabby, and bloodless. The cysts are, 

 for the most part, isolated. Occasionally, how- 

 ever, they abut one upon another, so as to 

 form a single multilocular capsule. Here, as 

 elsewhere, they are composed of two mem- 

 branes ; namely, an external filamentous, and 

 an- inner serous, one. The external membrane 

 is either smooth, or sends forth bands which 

 attach it closely to the rest of the texture ; 

 in many instances it partially, if not wholly, 

 ossifies. The sac contains a limpid fluid, or 

 a number of secondary hydatids *, or, again, 

 a jelly-like substance, but more commonly a 

 yellowish or whitish crystalline pulp, consist- 

 ing almost wholly of cholesterine crystals 

 with phosphate and carbonate of lime. In 

 some instances the cyst accidentally inflames 

 and becomes atrophied ; in others it gradually 

 fills with earthy matter, and is transformed 

 into a hard calcareous nodule. Cysts occur 

 in the thyroid gland, in both sexes, and nearly 

 at all ages ; more frequently, however, in 

 females after the prime of life." A remarkable 

 case of cystic formation in the thyroid is 

 mentioned by Andral. He states that the whole 

 organ was converted into a cyst with bony 

 walls filled with a honey-like fluid. He seems 

 to recognise both the cystic and melicerous 

 degeneration as further stages of the per- 

 verted or excessive action which occurs in 

 simple hypertrophy, and justly refers to the 

 case of the ovary as exactly analogous, the 

 cysts of which, filled with various products, 

 originate, in all probability, in Graafian vesicles, 

 which undergo an abnormal development. 



Prof. Hasse has never met with tubercles 

 occurring in the thyroid. Prof. Louis makes 

 no mention of such an occurrence, nor does 

 M. Papavoine in a table which he gives of 



* Lieutaud mentions a case where the trachea 

 was perforated by one of these acephalo-cysts. 



the seat of tubercle in various degrees, drawn 

 up from the examination of the bodies of fifty 

 children. 



Sauten has observed that persons affected 

 with extensive bronchocele seldom or never 

 become subjects of phthisis. 



Carcinomatous growths rarely affect the thy- 

 roid. Eight cases in 8289 of deaths occur- 

 ring from cancer in Paris, are ascribed to this 

 part. * The disease is sometimes primary, 

 sometimes secondary, or the result of invasion 

 from some neighbouring affected part. 



Encephaloid or scirrhus in several of 

 their varieties have been known to occur in 

 the organ, but no example of colloid in it has 

 yet been detected : of course cysts filled with 

 melicerous contents must not be confounded 

 with the loculi of real colloid, to which they 

 bear some resemblance. Primary cancer in 

 the thyroid usually exhibits the characters of 

 scirrhus, secondary those of encephaloid : in 

 the first case the disease is usually infiltrated, 

 in the second of the tuberous form. Ence- 

 phaloid here, as elsewhere, often grows rapidly, 

 and attains a large size. It seems to ob- 

 literate entirely the natural appearance of the 

 gland. It is often of the h<zmatoid variety, in 

 which there is sometimes softening in the 

 centre of the mass, causing rupture of vessels 

 and extravasation of blood. Occasionally 

 black pigment is accumulated within its texture 

 in varying amount, " Medullary cancer of this 

 gland must not be confounded with that of the 

 lymphatic glands of the neck, which often 

 simulates goitre." 



Enlargement of the Vessels. The last 

 kind of morbid degeneration, which the thy- 

 roid has been observed to undergo, is that 

 to which the term vascular or aneurismatic 

 bronchocele has been applied. It is de- 

 scribed as follows by Professor Hasse, " All 

 the blood vessels are much amplified, the veins 

 in particular forming very dense, capacious, 

 often knotted, plexuses, and the whole texture 

 consisting apparently of a dense coil of vessels. 

 The substance of the gland has almost en- 

 tirely lost its granular character ; it is flabby 

 and dark red. After death the tumour col- 

 lapses considerably, and can only be restored 

 to its original size by artificial injection. The 

 walls of the arteries and veins are attenuated, 

 the dilated membranes of the vessels contain 

 considerable clots, and capacious cavities are 

 found filled with black coagulated blood. 

 Vascular;bronchocele affects the entire gland; 

 principally, however, one or other lobe. It 

 occurs most frequently in females after the 

 prime of life, and is, like simple hypertrophy, 

 marked by periodical augmentation and de- 

 crease. This general dilatation of blood- vessels 

 must not be confounded with the exuberant 

 vascular (malignant) growth termed fungus 

 hoematodes, to which the thyroid gland is also 

 subject." In the foregoing description we 

 have clearly set forth the condition of an 

 organ, the walls of whose vessels have, from 

 loss of their natural tonicity, yielded to the 



* Walshe on cancer. 



