Journal : Photographic review of medicine & surgery ; vol. 2., no. 2.
Philadelphia : J. B. Lippincott & Co., 1871-72.
Description : pp. 17-18,  pl. ; ill.: 1 photo. ; 24 cm.
Photograph : mounted albumen.
Subject : Cystic thyroid — Thyroidectomy.
DURING January of the present year, my colleague Dr. Parry, of the obstetrical staff of the Philadelphia Hospital, asked my advice in reference to a tumor of the neck, in a patient then an inmate of his wards. After repeated and careful examinations, it was clearly defined to be an enlarged thyroid gland.
The history was as follows: The woman was 23 years of age, born in Cheshire, England, and when nine years old first discovered a small swelling on the anterior part of the neck, its situation being somewhat to the right of the median line. This slowly but gradually increased up to the date of my seeing her. She then complained of but little pain, some difficulty in deglutition, and scarcely any obstruction to her respiration, save in certain positions. She manifested great desire to be rid of the tumor, though the strongest representations of the gravity of the operation were fully made and understood. It was decided to attempt the reduction of the tumor by the process of electrolysis. This was fully tested and afterward abandoned, the result being entirely negative. In February, before extirpation was resorted to, a final effort was made to produce an impression on the morbid mass by electrical cauterization, which was effected by means of a large Bunsen's battery of fifteen cells. This procedure was more effective than the former. The phenomena here evolved were of a very interesting character. A perceptible crackling noise was audible in the tumor during the application of the needles, which were heated almost to a white heat. Great induration was developed around the negative pole, and the tumor at once began to increase in size, measuring before the operation sixteen inches, and in two hours, seventeen. Great dysphagia also followed, and excessive pain when the parts were touched or the head moved. During the day following, all the symptoms of acute inflammation were present ; these, however, began to subside in a few days, leaving the patient in her former condition, save the induration around the site of entrance of the negative pole. In April it was finally decided to resort to the knife. The patient being fully influenced by chloroform, an incision five inches in length was made over the most prominent part of the growth, parallel with its perpendicular diameter, and this joined by a horizontal one of sufficient extent to allow free manipulation during the operation. The firm, dense capsule of the gland was soon reached by division of the bands of fascia overlying. It was soon seen that the thyroid arteries were greatly enlarged, more especially the right and left inferior. All these were well secured in turn, as likewise all smaller vessels. In this way absolutely all hemorrhage was avoided.
The cyst was then peeled away from the trachea for the extent of three and a half inches. The sheath of the right carotid was undisturbed, but fully exposed, as also that of the left. The wound was closed, no hemorrhage followed, and the patient did well, excepting a slight attack of erysipelas, which came on three days after, and, queerly enough, involved the face and portions of the neck to the entire exclusion of the wound.
Remarks.—This case is pregnant with interest, but space will not admit of its free elaboration. It must suffice to say that here the repeated use of electricity would not have availed much, as the consistency of the tumor would have resisted it entirely, or the time occupied by this mode of treatment would have compassed many months. When the capsule was opened, the structure was found to be dense, and very tenacious in character, and not apparently very vascular. The belief that this operation in many cases can be effected is confirmed by the fact that I removed, some weeks after, another very large growth of the same kind in the same manner, and with the best result, as respects hemorrhage and shock. This patient did well for twenty-one days, and was then seized with pneumonia and perished, after all the ligatures had become detached and the wound almost healed. The subject of this photograph was seen some days since in the enjoyment of perfect health. She has never experienced any difficulty, save slight aphonia, which has now disappeared.