Gastrostomy, radical cure of hernia, and thyroidectomy : an address delivered at the opening of the Section on Surgery at the Annual Meeting of the British Medical Association, held in Belfast, July and August, 1884 / by Sir William Mac Cormac.

  • Maccormac, William, Sir, 1836-1901.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Gastrostomy, radical cure of hernia, and thyroidectomy : an address delivered at the opening of the Section on Surgery at the Annual Meeting of the British Medical Association, held in Belfast, July and August, 1884 / by Sir William Mac Cormac. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    double ligatured and divided between. The artery is generally much enlarged, and its walls are very thin. Search is now to be made for the inferior thyroid artery, which must be most carefully isolated previously to ligature. This may be applied as far as possible from its entrance in- to the tumour as Kocher recommends (see Fig. 3). In this way the recurrent nerve shall be well protected from injury. The inferior thyroid artery after leaving the thyroid axis passes transversely behind the outer border of the thyroid, and for some distance on its posterior surface, before it penetrates the gland, after dividing into several branches. Close to the trachea the trunk of the artery passes behind the recurrent nerve, which it partly encircles. The branches of the artery may be divided, after ligature, close to the surface of the gland, and bleeding will not occur, owing to the preliminary ligature of the main trunk. This proceeding I did not adopt in my case, but tied the vessels close to the surface of the gland. As Baumgartner of Baden-Baden points out, the small vessels supplying the oesophagus, trachea and larynx, are less liable to injury in this way. The recurrent laryngeal Baumgartner thinks, is safer, and cachexia stru- mipriva also less likely to occur. In his communication to the last Congress of German Surgeons (1884), Baumgartner narrates particulars of nineteen cases of operation. Eleven of these were total excisions. In four some of the symptoms of cachexia strumipriva were subsequently ob- served, and in two of these the evidence of the malady had almost entirely disappeared after tracheotomy was per- formed. At the same meeting, Crede of Dresden reports twenty-two cases, with twenty-one recoveries. Fourteen of these were complete extirpations. Crede had never seen a case of Kocher's cachexia, not even in a boy of 16 on whom he operated. Cred^ likewise lays stress on dividing the branches of the inferior thyroid artery close to the surface of the tumour, for reasons similar to those of Baumgartner. I feel sure it is the better plan. The tumour may now be turned towards the median line and lifted from the trachea. The further isolation should be conducted as carefully as possible until the isthmus is reached, which should be most