Congenital goitre / by Alexander R. Simpson.

  • Simpson A. R. (Alexander Russell), 1835-1916.
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: Congenital goitre / by Alexander R. Simpson. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    posterior extremity of the right nympha, got torn on the pro- minent tuber parietale, there was nothing else noteworthy in the delivery. Immediately on the birth of the child, which was a male, when it was laid on its back I noticed that there was a swelling of some sort on the front of the neck, and delayed the ligaturing of the cord for a short space, as respiration seemed to be effected only with the greatest difficulty, and with strong convulsive movements of the muscles of the head and upper extremities. After the cord had been tied and divided, and the child handed over to the nurse, whilst I was attending to the labour in its third stage, I could hear the rough, hoarse, crack- ling sound of the laboured breathing, which gave an impression as if there was some fluid in the narrowed larynx. On examin- ation, it was at once evident that the swelling, which projected to the level of the chin, and occupied nearly all the space between the chin and the sternum, was due to an enlargement of the thyroid gland. The isthmus could be felt passing in front of the trachea, and terminating in the two lateral lobes, all in their natural relation, and retaining then normal config- uration; only all greatly increased in size, the right lobe slightly more hypertrophied than the left. Whilst being moved about, during the process of dressing, the infant had in some positions increased difficulty of breathing, more particularly when it was placed in somewhat of a sitting posture, so as to let the chin press upon the tumour; and, whenever it at- tempted to cry, the swelling became more prominent. For the first eight hours the quantity of fluid in the trachea continued undiminished, but the secretion then began to clear away, and, after twenty-four hours, there was no longer any crackling; although the hoarse, laboured breathing continued so loud for some days afterwards as to attract the notice of any one entering the room. Attempts at deglutition during the first twenty-four horns greatly aggravated the difficulty of respir- ation, but after that period both functions were performed with progressively increasing ease. During the first fortnight, whilst I had the child under frequent observation, there was no very marked change in the size of the swelling. There had been a certain degree of congestion at the date of birth which, during this period, had subsided, so as to leave the neck of somewhat diminished circumference; but the tumour remained firm, and by its protrusion attracted the attention of any one in whose arms the child was placed. But when, about four months afterwards, I again had an opportunity of seeing it, the tumour was diminished in size to about half its original bulk ; and, as the infant had thriven extremely well, and grown veiy