Endemic goitre or thyreocele : being the thesis for the degree of Doctor of Medicine of the University of Durham for which the gold medal of the year 1884 was awarded together with subsequently-added footnotes and appendix / by William Robinson.
- Robinson, William H., 1955-
- Date:
- 1885
Licence: Public Domain Mark
Credit: Endemic goitre or thyreocele : being the thesis for the degree of Doctor of Medicine of the University of Durham for which the gold medal of the year 1884 was awarded together with subsequently-added footnotes and appendix / by William Robinson. Source: Wellcome Collection.
Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.
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![merited inspiratory efforts causing a greater influx, by suction, of the blood from the large veins into the heart, and so pro- ducing (at first) pallor of the skin also. This pallor soon gives place to cyanosis should the engorgement of the right heart persist or increase, owing to the subsequent overloading of the systemic veins, which is also brought about or increased if the expiratory efforts require much muscular exertion, as then the flow from the large veins into the heart is impeded ; when, if the compression be very severe and increasing, the heart, owing to the engorgement of the right side, and the in- creasing venous character of the blood, becomes exhausted, the pulse becomes feeble and often intermittent, and in the worst cases finally ceases. [A lesser cause of the feebleness of the pulse may be that the increased inspiratory efforts tend to cause expansion of the aorta, and so to impede the outflow of blood from it into the smaller arteries.] Pressure upon the recurrent laryngeal nerves. The recurrent nerve, from its position by the side of the trachea, between that tube and the gullet, is the nerve most exposed to pressure from a thyreocele. This nerve supplies with motor power the two antagonistic sets of muscles —the Adductors and tf^ductors—of the vocal cords. Experimental physiology teaches us that mechanical stimulation of the w hole nerve-trunk results in closure of the glottis—the ad- ductors overbalance the abductors ; hence the explanation of spasm of the glottis ensuing from the irritation of this nerve by a goitre. Should, however, the pressure be great or of long duration, paralysis (generally incomplete ') of the muscles supplied by the nerve results, the affection being bilateral or unilateral, according as both nerves or one only is implicated. 1 Complete paralysis (i.e. of both abductors and adductors of the vocal cords) from simple goitre must be very rare if it ever occurs. There are such cases, however, on record from malignant hypertrophy of the thyroid. In this form of laryngeal paralysis the vocal cords (as may be seen by the laryngoscope) remain immobile in the 'cadaveric ' position, i.e. midway between the median position of phonation and the lateral position of deep inspiration. There is no dyspnoea ; the voice may be weak or lost, and as the patient cannot adduct his vocal cords when he tries to speak, much of his breath is wasted, so that he requires to make very great exertion to throw the cords into vibration. He cannot cough. There may be some amount of stridor on forced inspiration.](https://iiif.wellcomecollection.org/image/b21447597_0021.jp2/full/800%2C/0/default.jpg)
