Goitre : a contribution to the study of the pathology and treatment of the diseases of the thyroid gland / by F. de Quervain.

  • Fritz de Quervain
Date:
1924
Catalogue details

Licence: In copyright

Credit: Goitre : a contribution to the study of the pathology and treatment of the diseases of the thyroid gland / by F. de Quervain. Source: Wellcome Collection.

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    muscles, and internally by the perithyroid fascia, which constitutes the deep layer of the sheath of the small muscles. Posteriorly it extends, like the preceding compartment, to the blood-vessel compart¬ ment, without however merging with it. (3) Thyroid (or visceral) compartment, which contains the thyroid gland, the trachea and parathyroids. It is bounded externally by the perithyroid sheath (thyroid fascia) and on the visceral side by the true capsule of the thyroid. (4) The blood-vessel compart meat contains in two well-defined sub¬ divisions the internal jugular vein and the carotid artery accompanied by the vagus nerve. These four spaces extend posteriorly as far as the deep cervical aponeurosis, which is itself divisible into at least two distinct layers. The two former spaces merge with each other towards the narrow superior aperture of the thorax ; but at the level of the isthmus of the thyroid—which is the important position from the operative aspect—the two spaces are quite separate. Unless one employs a considerable amount of force, it is impossible to make the gelatine pass from one space into another, and this fact renders it quite easy to fill each compartment with a differently-coloured gelatine. As already stated, the parathyroids are within the thyroid compartment, and the same applies to the recurrent laryngeal nerve at this level. The blood-vessel compartment contains the vagus, and also the trunk of the sympathetic nerve, surrounded by a fine lamina of connective tissue. The anterior layer of the deep fascia of the neck separates the inferior thyroid artery from the blood-vessel compartment. The artery passes through this layer behind the thyroid gland, very often at the level of its bifurcation. It is also at this level that it crosses the recurrent nerve. The following method of investigation was carried out in a second series of experiments. After a preliminary injection of the arteries of the body with red gelatine, and of the veins with blue gelatine, all the spaces of the neck were infiltrated with a transparent colourless gelatine. The neck was then frozen, and a section 2I cm. in thickness was cut at the level of the seventh cervical vertebra. This section, prepared according to Kaiserling’s method, was immersed and pre¬ served in transparent gelatine. The tissues were thus subjected to a kind of artificial oedema, which made the various aponeurotic layers stand out very clearly. This oedema is shown in fig. 2. The following are the main conclusions which may be derived from a study of these preparations (see our publication of 1915). (1) The sterno-cleido-mastoid compartment is bounded internally by an aponeurotic layer which is usually thick enough to represent, at the same time, the external layer of the small muscles compartment and the common external sheath of the sterno-hyoid and sterno-
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