The surgery of Egypt / [Frank Cole Madden].

  • Madden, Frank Cole.
Date:
1919
Catalogue details

Licence: Public Domain Mark

Credit: The surgery of Egypt / [Frank Cole Madden]. Source: Wellcome Collection.

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    fixed from the beginning and are much harder than the ordinary goitre. The growing mass becomes irregular in shape, the superficial veins become very much enlarged, and the growth becomes firmly fixed to every struc- ture in the neck. The trachea is pushed aside, rather than constricted by external pressure, and at late stages may be infiltrated with growth. Enlarged hard glands may be felt deep in the neck; and secondary growths, in the sternal end of the clavicle, on the skull, and in other parts of the body and viscera, may appear at any time. Both sarcoma and ‘arcinoma are met withand they are equally rapid and dangerous. From ignorance of the danger and indifference, late cases of malignant goitre are only too commonly seen here, especially in men, and with but little hope of successful treatment. We have nothing interesting to add of special local bearing on the signs and symptoms of an ordinary goitre; and, from the scattered distri- bution of the disease, in spite of the universal drinking of Nile water, we cannot contribute anything to the elucidation of the problem of the causation of goitre, .which is now being so closely investigated by McGarrison and Farrant. There are several important points to be noticed in the operation for goitre, and it will be well to describe our practice in this respect in some detail. As a rule, chloroform is used as the anaesthetic. A preliminary injection of morphia or scopolamine is of considerable benefit and much reduces the amount of chloroform required. Local anaesthesia may also be employed after a preliminary injection of morphine and atropine, or scopolamine, and often proves very successful if properly induced. With strictest aseptic preparations the neck is put slightly on the stretch, by placing a small pillow under it, and a free cut-throat incision made from the outer border of one sterno-mastoid to the same point on the other side, about the level of the ericoid cartilage and not toolow down in the neck or the resulting scar will lie ina bad position. Skin flaps are dissected up and down till the whole goitre is thoroughly exposed. The platysma and the cervical fascia are then divided in the line of the origi- nal incision, and the superficial veins secured with forceps, before they are divided, as far as possible. The greatest care must be taken to secure any vessel that is cut or is bleeding, or may bleed, not only now but at every stage of the operation. Whenever possible the vessels should be caught first and then divided between two pairs of forceps. This prevents any unnecessary bleeding during the operation and minimises the risk of any haemorrhage after it. The sterno-thyroid and sterno-hyoid muscles are next divided transversely and when this is done, and the deep cervical fascia behind them, which forms the real capsule of the thyroid, incised, the thyroid mass is exposed and can be easily enucleated with the finger from its surroundings. It is worse than useless to attempt to shell outa thyroid until this stage has been reached; and equally important not to cut through the true capsule of the gland or severe bleeding will ensue.