Thyroid adenoma and cystic accessory thyroid : removal / by Robert Jones and W. Thelwall Thomas.

  • Jones, Robert, 1857-1933.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Thyroid adenoma and cystic accessory thyroid : removal / by Robert Jones and W. Thelwall Thomas. 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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    moment it is discovered or even suspected. Section 34 of the Contagious Diseases (Animals) Act provides for the registration and inspection of dairies, cowsheds, and milk- shops, and is a necessary and useful Order ; but its adoption snot obligatory, and consequently it has been only a partial success. I know of more tnan one local sanitary authority that refused to appoint an inspector under this section, though they were asked to do so by the Local Government Board immediately after their respective districts had been widely visited by typhoid fever, the result of infected separated milk.3 In July, 1894, the Limerick bench of magistrates held that the Food and Drugs Act did not apply to milk sold to creameries, and they therefore dismissed a summons against a man for such adulteration. In a recent outbreak of fever in the Carrick-on-Suir union Dr. Moran reported that on the appearance of the disease on a certain farm the cows were transferred to an adjoining one, where the milking was carried on by the inmates cf the infected house, and the milk after this exposure to infection was sold to the same creamery that the farmer had been previously prohibited from supplying. These are not examples of mere failure of administration of our present laws, but they are proofs of the necessity of fresh legislation required by a system the dangers accompanying which were not fully known when our recent Acts were framed. To render our existing laws at all efficient they should be extended to every part of the United Kingdom, and not confined to those districts whose sanitary authorities are sufficiently enlightened to adopt them ; but, in order to grapple with the matter thoroughly, rules such as are enforced by the continental creameries should be made compulsory, and should be carried out under State supervision. I know that all necessary regulations are rigidly followed in many of our dairies and creameries, but in others they are completely ignored, and they will continue to be so until the State compels their adoption. Disease can also be conveyed by the cream, and an outbreak of scarlet fever at South Kensington was thus accounted for. Prolessor Lane Notter traced several cases of typhoid fever to the use of cream procured at a dairy where this disease had broken out, and Dr. Thorne Thorne saw cases of typhoid fever and of diphtheria that were caused by cream from infected milk. He explained the implication of the cream as “merely the mechanical effect of the oil globules in rising taking with them the germs to the surface. ” Perhaps equal danger does not exist with cream obtained by the separator, as the tendency would be to have the heavier bacteria driven forcibly from the centre where the lighter cream collects. The discoveries of Professor Bang of Denmark, and of Mr. Beebe of the New York Health Department, threaten to considerably widen the interest of the whole question, and to make the demand for reform imperative. It was formerly thought that cheese and butter could not convey disease germs, but Professor Bang exploded this gratifying belief when he proved that both these products of the dairy are capable of deriving living and active tubercle bacilli from the milk. Since then there has been an uneasy suspicion that other disease germs may also find a suitable home in the same articles of diet, but in the absence of positive proof these fears seldom found expression. Now, however, Mr. Beebe has demonstrated that over 30001b. of cheese con- tained the Klebs-Loffler bacillus, and on investigation it was found that a fatal case of diphtheria had occurred in the family that supplied milk to the factory in which the cheese was made. Many creameries make an inferior cheese from separated milk, but the more important question is, Can this germ, or the bacillus of typhoid fever, find its way from the milk into the butter? At present there is no proof that such can occur, but, reasoning from analogy, the conclusions cannot be reassuring. It is now known that the diphtheria bacillus can so pass in cheese-making ; the heat used in this manufac- ture is not capable of destroying the germ, and one cannot point to any process in the making of butter that is calcu- lated to do so, as the acid developed in the ripening of cream is not fatal to the typhoid bacillus. Butter contains about 16 per cent, of water, which is derived from the milk, and it must have been by means of this that the tubercle bacilli discovered in butter by Professor Bang were conveyed, and undoubtedly there is some danger, no matter how small, of 3 In the late outbreak in Castleisland, which was “ clearly traced, to infected milk.” there were between 8C0 and 900 cases of typhoid fever; yet on its termination the sanitary authority refused to appoint a dairv inspector. other pathogenic germs passing over in a similar way, though, for the reasons mentioned just now, it is probable that, other things being equal, the presence of disease germs in butter is less to be feared when the cream from which it was made has been separated by the centrifugal machine ; the weakness of our modern method of butter-making does not lie in the process of manufacture, but in the mixing together of the products of all sorts of dairies which are frequently under no supervision whatever. In conclusion, it is undeniable that many diseases have been conveyed by milk which was either procured from infected animals or was subsequently contaminated by the addition of impure water &c.; that both cheese and butter have derived the tubercle bacillus from milk ; that cheese has in the same way become impregnated with the diphtheria bacillus ; and that several pathogenic germs, once they get into butter, can live there for considerable periods, cholera bacilli having been found in it thirty-two days after they were purposely intro- duced, typhoid bacilli after three weeks, and tubercle bacilli nearly three months later. To follow butter obtained from a suspicious source and to conclusively prove that harm results from its use is a task surrounded with almost insuperable difficulties, and mere negative results in such an important question cannot be considered as final. It is not in a spirit hostile to an important industry that I direct attention to these matters, but to impress on the State the necessity of adopting measures similar to those which are in force in the most flourishing agricultural countries of the Continent. In Germany a dairyman who sends adulterated milk to a creamery renders himself liable to a fine of 3s. for every quart of milk delivered. In Denmark, if milk be sent from a house in which infectious disease exists, a fine of £5 is inflicted on the delinquent ; creamery dairies are regularly seen by an inspector; and “veterinary surgeons visit the farms once a fortnight, when every case of disease among the cattle is isolated.” Our own agriculturists would be benefited by the universal adoption of such rules, but the public health has even higher and more urgent claims. In the words of Professor Crookshank, “the health of the community must take a first place ; the happiness and prosperity of our country and the preservation of our imperial supremacy largely depend upon keeping our invisible foes in check and main- taining the highest possible standard of public health.” But in spite of all our boasted advance in sanitary science these foes still come in what should only give us life and strength, for “there is death in the pot,” and it has been my endeavour to expose one unguarded channel by which it gains entrance. Postscript. — The cases in the houses of Mr. B and Mr. C did not come under the notice of the medical officers of health for their respective districts, and, the Infec- tious Disease (Notification) Act not being in force, no official information was supplied by occupiers or medical attendants. Bandon, Ireland. THYROID ADENOMA AND CYSTIC ACCES- SORY THYROID; REMOVAL. By ROBERT JONES, F.R.C.S. Edin., SURGEON TO THE ROYAL SOUTHERN HOSPITAL, LIVERPOOL; AND W. THELWALL THOMAS, F.R.C.S. Eng., ASSISTANT SURGEON TO THE ROYAL INFIRMARY-, LIVERPOOL. The growth occurred in a patient aged twenty-seven years. When quite a little girl her parents noticed a small, freely movable lump under the skin of the left side of the neck, just above the collar-bone. The swelling was painless and “grew with her.” In her twentieth year she consulted Mr. Whitehead of Manchester, who examined the neck and told her it consisted of enlarged glands and not to worry about it ; he recommended the local application of tincture of iodine. The only inconvenience the growth caused, according to her statement, was an occasional feeling of choking when she lay down in bed. She is a married woman and has one child. Four and a half years ago another enlargement appeared higher up in the neck on the same side, near Adam’s apple, but the original swelling appears to have remained quiescent about this period, only to increase recently, which caused her to consult