Operations on the thyroid gland / by Sir William Stokes.

  • Stokes, Sir William, 1839-1900.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Operations on the thyroid gland / by Sir William Stokes. 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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    then developed exophthalmos and goitre, and suffered ultimately fiom such dyspnoea that laryngotomy was performed, and Koenig’s long cannula inserted into the trachea. Subsequently the left lobe of the thyroid was removed ; the result was most successful. Seven months after, the enlarged right lobe had disappeared, as well as the exophthalmos and the cardiac disturbance. The second case was that of a male, aged forty-seven, in whom the symptoms and signs of Graves disease were AArell marked. In this case operative interference was attended with equally good results. The right lobe was removed—an operation attended with great haemorrhage— but the recovery was rapid, and in every way satisfactory. Having regard to these cases, and the remarkable results obtained from ligature and excision of the isthmus, it is a matter worthy of consideration whether this latter and less hazardous operation might not be undertaken Avith a good prospect of success in exophthalmic goitre. When Ave consider the exceptional difficulties, dangei’S, and serious sequelae that at times attend immediately or occur remotely after thyroidectomy, Avhether it be complete or partial, such as haemorrhage, tracheal collapse, injury to the recurrent laryngeal nerve, tremors, convulsions, sudden dyspnoea, shock, septic infiltra- tion, nerve degeneration at a situation remote from the field of operation, myxeedema and cretinism, it is remarkable that a method of procedure—namely, ligature and excision of the isthmus—that, so far as our experience goes, does not appear to be attended Avith the same risk, has not merited a greater attention at the hands of surgeons than it has hitherto done. I do not know of any case except those of Mr. Ilolthouse, who has narrated the particulars of two cases, Mr. Sydney Jones, Avho has had four alluded to by Sir Willliam MacCormac in his able surgical address in Belfast in 1884, and my three cases. These are very feAv, but still the results are distinctly encouraging. Mr. Jacobson, in his excellent work on Operative Surgery, says :—“ 1 would most strongly urge a further trial of this operation in cases of general enlargement of the gland, especially when the isthmus itself is enlarged.” (P. 438). Should the experience of surgeons in the future coincide with that which has been already acquired, limited though it be, a very great advance Avill be acknowledged to have taken place in the treatment of one of the most serious conditions that the operating surgeon may be called upon to deal with.
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