. The diseases of children : medical and surgical. ients were young adults, the third was an ill-developed, idiotic child, in whom there was enlargement of the tonsils, withpost-nasal vegetations ; these had been dealt with once with marked im-provement, but on the second occasion sudden dyspnoea, evidently due topressure of the enlarged thyroid, was brought on by an attempt at examina-tion, and on administering chloroform the breathing stopped ; tracheotomywas performed, and the child did fairly well for a day or two, but died ofbronchitis on the 3rd or 4th day. The operation under such circu
. The diseases of children : medical and surgical. ients were young adults, the third was an ill-developed, idiotic child, in whom there was enlargement of the tonsils, withpost-nasal vegetations ; these had been dealt with once with marked im-provement, but on the second occasion sudden dyspnoea, evidently due topressure of the enlarged thyroid, was brought on by an attempt at examina-tion, and on administering chloroform the breathing stopped ; tracheotomywas performed, and the child did fairly well for a day or two, but died ofbronchitis on the 3rd or 4th day. The operation under such circumstancesmay be of difficulty alike from the presence of the large mass ofgland, from the engorgement of the vessels, and from the altered shape ofthe trachea, which is compressed laterally. A specially long tube is requiredto reach down below the constricted part of the windpipe. There is no On a Case of Acute Enlargement of the Thyroid Gland in a Child, by Dr. , Cliii. Soc. Trans, vol. xxi. 778 Diseases of the Thyroid and Thymus. doubt that in any case where attacks of dyspnoea, thyroid asthma, haverecurred, either removal of part of the gland or division of the isthmusshould be performed in an interval between the attacks.^ In simple casesof goitre the treatment is the same as for adults. We have divided the thyroid isthmus in a young gentleman of sixteen, inwhom acute attacks of almost fatal dyspnoea had more than once occurred. The trachea was much flattened late-rally (scabbard trachea). Three weeksafter operation the gland had resumednearly its normal size. In another casethe operation was done during anattack, and the patient died a fewhours later from rapid oedema of thelungs. In another, part of the glandwas removed and tracheotomy per-formed ; the patient recovered, thoughin cases where tracheotomy is neces-sary the danger to life is much in-creased. It is not very uncommon to seechildren in whom the thyroid isslightly enlarged and sometimes pain-ful
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