Chapter XXXVII

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STRUMITIS.

Strumitis is a term applied to actual inflammation of an already goitrous thyroid. It may follow such infectious diseases as typhoid, or it may be an apparently spontaneous infection without known cause. It may run an acute course, tending rapidly to suppuration, in which case there will be not only pain and tenderness in the thyroid itself, but all the local evidences of pyogenic infection, with infiltration and rapid formation of pus, perhaps with widespread phlegmon of the neck. This is a serious condition and may call for early and free incision of the infected area. A hemorrhagic form of strumitis is also known. The thyroid may also be the site of metastatic abscesses in cases of pyemia, in which case there will be but few local indications.

THE THYMUS.

The thymus figures but rarely in surgical interest, but when seriously affected it causes most pronounced symptoms. Its principal activity is shown previous to birth and during the earliest months of infancy, and it should have disappeared by the age of puberty. Instead of atrophying, as it should, it may undergo _hypertrophy_, by which, on account of its location, serious pressure is made upon the trachea and the base of the neck. This may occur suddenly, so that a tumor in its location rapidly develops and will prove fatal unless surgical relief be afforded. This constitutes an acute hypertrophy of the thymus, which is more than a mere surgical curiosity. In one case seen by me a long trachea tube was with difficulty inserted just in time to prevent death by asphyxiation. In case of such tumor the upper end of the sternum should be removed and the tumor enucleated, or the thymus should be sewed up to the sternum and the tumor thus raised out of its bed.

The thymus is of special interest in connection with the _status lymphaticus_, which has been referred to in a previous chapter. Its connection in such cases with hypertrophied lymphoid elements all over the body, and especially of the adenoid tissues of the nasopharynx, was therein described, and the seriousness of the condition, with the menace which it offers to anesthesia, as well as the extreme cautions to be observed, were fully rehearsed. The significance of laryngismus stridulus and its relations thereto were also mentioned. All this is of extreme importance to the surgeon, as every child with so-called thymic asthma, and with symptoms of lymphatism, should be watched carefully and anesthetized cautiously. (See