Twenty-four operations performed for the extirpation of goitre, 15 being total and 9 partial; of the former, 5 proved fatal. In 10 cases no symptoms of ca chexia strumipriva or myxcedema have appeared in periods varying from one to four years, Bardeleben (Deut. Zeit. f. Chin, B. 26, H. 1, 2, 'SS).
Unilateral extirpation performed in 5 cases, with improvement in all. One of the cases had a severe recurrence two years after the operation. Immediately after the operation there was observed a most striking retrogression of all symptoms of the disease. J. Wolff (Deut. med. Woch., Mar. 16, '92).
Statistics of forty-one operations for exophthalmic goitre given, with only two deaths. Those cases classed as sur gical in which the nervous symptoms seem directly dependent upon the size and growth of the goitre. Albert H. Freiberg (Med. News, lxiii, 225, '93).
Operation of extirpation of goitre in Graves's disease is dangerous. Kocher (-lied. Week, iii, 194, '95).
Ligature practiced in twenty-two eases of Graves's disease. All four ar teries tied without any symptoms of caehexia. Rydygier (3Ied. Week, iii, 195, '95).
One hundred and thirty-eight cases in which operation was undertaken. Of these, 114 were improved, 17 cured, and 4 died. Abram (Lancet, Nov. 16,'95).
One hundred and eighty-seven cases in which surgical operation was under taken. Of these, 13 died as the result of the operation, 00 recovered, 47 improved, 11 were unimproved, and in 25 the re sult is unknown. Kinnicutt (Med. Record, Apr. 18, '96).
One hundred and ninety cases of ex ophthalmic goitre in which some form of operation was done. Of these, 74 are reported as completely cured, many of them having been watched two or four years before the result was published. Exophthalmos sometimes persisted for a year after operation ; 45 of the cases were improved and 3 were not benefited ; 23 eases died immediately after opera tion, and, as hremorrhage was not the cause and careful aseptic precautions were taken, the writer holds that the cause of death is a sudden poisoning of the system by excessive absorption of thyroid juice. This may be due to the manipulation of the thyroid gland or to the increased absorption of torn vessels or to the stimulation by the ether.
Local anmsthesia by cocaine should be used instead of ether. Starr (Med. News, Apr. 18, '96).
Section of the sympathetic is neither dangerous nor difficult. It powerfully affects the triad of symptoms, and this effect is permanent, especially so after exophthalmos. It can be practiced concurrently with other interventions, provided they have not diminished the exophthalmos. Gayet (Lyou Med., No. 30, '96).
Operating in exophthalmic goitre by bilateral complete removal of the sym pathetic ganglia in the neck advocated. The operation itself is difficult of per formance, and in some cases. owing to the fusion of the lower cervical with the upper dorsal ganglia, and to the close investiture of the trunk by important and intricate net-work of vessels. is im possible. While some surgeons, after division of the sympathetic trunk on one side, have observed no papillary or similar changes, others have. The author has usually found myosis, in creased salivary and lacrymal secretion, ptosis, and flushing of the face, but these symptoms were very transitory, and so slight that when the operation is bilateral, and when thus one has no standard with which to compare, they often are quite invisible. Resection of even the whole of the cervical sympa thetic trunk on both sides does not necessarily produce any evil result: in exophthalmic goitre the operation is "absolutely indicated." Jonnesco (Ann. d'Ocul., Mar., '97).
Two eases observed in which ablation of the thyroid gland cured all the symp toms of exophthalmic goitre. When the patients were given thyroid extract, after the apparent cure, all the symp toms returned temporarily. The re moval of the gland is easy and devoid of danger, section of the sympathetic is useless and dangerous. Doyen (Semaine Mad., July 29, '97).
Cervical sympathetic excised in three cases. It is a "good operation," but ether should be used instead of chloro form, and the two sides of the neck should be operated upon at different times. Faure (Rev. de Chir., No. II, Suppl., '97).