It is this latter form in which cysts are
frequently found. The accompanying illustration pictures an
extreme ease of cystic goiter shown by Warren. A strange feature
of tumors of the thyroid is that pressure-atrophy and flattening
of the trachea do not take place in proportion to the size of the
tumor. A small tumor of the middle lobe of the gland, not larger
that a hen's egg, will do more damage to the trachea than will a
large tumor, such as that shown by Senn, after Bruns. When a
tumor has attained this size, pressure-symptoms are often
relieved by the weight of the tumor making traction away from the
trachea. Goiter is endemic in some countries, particularly in
Switzerland and Austria, and appears particularly at the age of
childhood or of puberty. Some communities in this country using
water containing an excess of calcium salt show distinct
evidences of endemic goiter. Extirpation of the thyroid gland has
in recent years been successfully practiced. Warren has
extirpated one lobe of the thyroid after preliminary ligation of
the common carotid on the same side. Green practiced rapid
removal of the tumor and ligated the bleeding vessels later. Rose
tied each vessel before cutting, proceeding slowly.
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