The Head and Neck 105 



The pathology of the Glandules does not appear to have been 

 studied up to the present. 



Treatment. Soft goiters generally respond to iodine medication 

 administered internally and by local inunction. Very large and con- 

 tinuous dosing is usually necessary. Exceedingly large growths 

 may be reduced by these means within a few days, but they tend 

 to recur. 



Fibrous goiters should be treated by strictly aseptic intra- 

 glandular injections of a few drops of tincture of iodine. After 

 the needle has been inserted it should first be ascertained that the 

 point has not lodged within the lumen of some enlarged vein, other- 

 wise it must be partially withdrawn and then reinserted. The dan- 

 ger consists in the immediate entry of the iodine into the venous 

 circulation. Horsley experimentally injected 15 c. c. of tincture 

 af iodine into the external jugular vein and brought about instantan- 

 eous death from cardiac paralysis by plugging of the right heart with 

 a hard clot. The injections should be repeated at intervals of several 

 days as soon as the inflammatory reaction has subsided. In some cases 

 several injections, lasting over a period of some months, are needed 

 to effect a cure. Bizard succeeded in producing absorption of an en- 

 largement in a dog aged five months by injecting the iodine into 

 the neighboring connective tissue instead of into the gland itself. 



Cystic struma is treated by free lancing of the sac and evacua- 

 tion of the contents, but it must be remembered that the secreting 

 membrane needs to be destroyed, which can be accomplished by 

 iodine injections directly into the sac ; otherwise a fistula islikely to 

 be established. An antiseptic tampon is then introduced in order 

 to stimulate healthy granulations. 



Malignant goiters being so extremely metastatic to important 

 internal organs, and being usually accompanied by profound 

 cachexia, scarcely warrant any attempt at giving relief even by sur- 

 gical means. Unilateral neoplasm in the early stages would justify 

 unilateral extirpation of the gland, provided the glandules were 

 healthy and left in situ. 



In any case of surgical interference it is absolutely essential 

 that at least one external glandule together with its blood-supply be 

 left intact and a successful outcome is more likely to take place if 

 both external glandules are allowed to remain undisturbed. 



