Congenital goitre / by Alexander R. Simpson.

  • Simpson, Alexander Russell, Sir, 1835-1916.
Date:
1866
Catalogue details

Licence: Public Domain Mark

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

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    butes the obstruction to paralysis of the muscles that dilate the rima glottidis. But, whatever be the explanation, this much is certain, that some infants, born with goitre, die immediately from the impossibility of respiration; others perish within a quarter of an hour or an hour after birth from the imperfect fulfilment of the function; and even when they have breathed somewhat more fully, and have survived for four, eight, or thirty-six hours, or even for three (Spiegelberg) or four days (Betz), they have eventually died in consequence of the im¬ peded respiration. In the non-fatal cases, the congestion, which seems to exist to a greater or less degree in all at the moment of birth, begins gradually to subside as respiration becomes established, so that after a few days the tumour is sensibly diminished in size, and, in those cases where the en¬ largement depends on an excessive turgescence of the vessels alone, the tumour may during that period have entirely disap¬ peared. Even where there has been some glandular hypertrophy as well, the gland in most instances becomes diminished in six or eight weeks to its normal dimensions. In some cases, however, absorption does not set in till a later period. Thus Bach tells of one in which the tumour, two months after birth, remained to all appearance unchanged: the infant had a habitually impeded respiration, slightly blowing in character, and becoming stertorous when he cried. I had an opportunity lately of examining Dr. Keiller’s former patient, who is now upwards of 11 years of age, and in whom no one, without having attention specially directed to it, would notice anything peculiar. He has, however, a slender, lady-like neck, and, when he throws back the head between the shoulders, an abnormal projection of the thyroid becomes apparent, and to the touch the body still feels somewhat larger than it ought to be. IY.—SYMPTOMS AND DIAGNOSIS. Before labour sets in there is no symptom that could lead us to suspect an enlargement of the foetal thyroid gland; but the moment a goitrous infant is expelled from the maternal passages, the existence of the tumour is manifested. 1. Swelling of the Neck.—A rounded swelling of variable thickness is seen running across the windpipe, and filling up more or less completely the space between the chin and sternum. In the least-developed cases it gives an appearance as if it were a double chin, of which the lower fold had rolled a little way down the neck; and from this it may give rise to varying degrees of deformity, according to the increase of its size, and