. The diseases of children : medical and surgical. res may be explained byfailure of the branchial arches to closein the middle line, or possibly by adeficient closure of the sinus is, however, most probable that such afistula, the thyro-glossal duct or canalof His, is, in the words of Dr. C. , who has kindly sent us hispaper on the subject, a remnant of themiddle thyroid rudiment of His. It isnot difficult to imagine, he says, thatthis may gradually become dilated at itslower end into a sac by the secretion of mucus from the wall of the canal,and that this sac ultimate
. The diseases of children : medical and surgical. res may be explained byfailure of the branchial arches to closein the middle line, or possibly by adeficient closure of the sinus is, however, most probable that such afistula, the thyro-glossal duct or canalof His, is, in the words of Dr. C. , who has kindly sent us hispaper on the subject, a remnant of themiddle thyroid rudiment of His. It isnot difficult to imagine, he says, thatthis may gradually become dilated at itslower end into a sac by the secretion of mucus from the wall of the canal,and that this sac ultimately causes the skin to give way by its pressuretill a sinus is formed. Dr. Marshall, in his interesting paper, points outthat these fistulas are not present at birth, but appear later, a strong pointin support of his view, which is now generally accepted.* H. E. Durham in the Trans. 1894, points out that the proofof a fistula being derived from the thyro-glossal duct depends upon— 1. A median position. 2. A ciliated epithelial Fig. 28.—Supernumerary auricle in the neck. 1 Vide Mr. Bland Suttons Lectures, Brit. Med. Jour. February 19, 1887, and Lancet,February 1888, and his book on Tumours, 1893. - Sir J. Paget [ Trans. 1878), from whose writings much of our informationon the subject is taken. ? Vide Gu/s Reports. ?* ^^^^ Sir J. Paget, op. cit. ; also Tillaux and others, Le Progres Midic. February 21,1885 ; Dr. C. F. Marshall, Jour, of Anat. and Phys. vol. ; also St. Thomass HospitalReports, 1890, and Brit. Med. Jour. May 1890. N 2 i8o Diseases of tJie Digestive System 3. Permeability through the foramen csecum. 4. Paired lumina resulting from the original bifurcation. 5. The presence of thyroid gland follicles. 6. A connection with the thyroid gland first two points are the most important. As these branchial fistulse give rise to very little inconvenience, it is usuallybest to leave them alone, especially as they are intractable
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