WONDERS OF MEDICINE & SURGERY.

Nelson Evening Mail, Volume XLII, Issue XLII, 11 June 1907, Page 4

WONDERS OF MEDICINE & SURGERY.

(By Dr AncVew Wilson, F.R.S.E.* in "Chambers' Journal" for March.) There exists in the neck region of man a certain organ known as the thyroid gland. This gland is divided into two halves, one of which is found on each side of the windpipe, the two lobes or parts being connected by a narrow bridge or isthmus. This organ constituted a grave puzzle in respect of its nature and its duties to the older physiologist. Unlike the liver or sweetbread, each of \vhich manufactures a fluid of Service in the digestive work, the thyroid gland did not appear to be concerned with the secretion of any particular substance. Examination of its structuro by the aid of the microscope did not Veveal any special features such as might-have formed the foundation of some adequate theory of its functions and uses in the frame. Only through its relations to a very curious nilment was the nature of the thyrcid gland discovered. It is needful here to explain that in hard-water districts this gland is apt to be enlarged, forming a tumor in the neck-region, to which the name of goitre is given. Locally in certain parts of England this trouble is known by the name of "Derbyshire neck" and "Yorkshire neck." The influence of drinking over-hard water, or, as some physicians are inclined to believe, the result of partaking of water containing certain minc.-als other that! those which con tribute to the nartiiless of the drinkinj supply, appears to act upon the thyrnic gland in a very peculiar fashion causing it to enlarge, and sometimes to a very great extent. Furthermore, however, it was dis covered that in a particular form of idiocy known as cretinism the thyroid gland was eithef> t Very imperfectly de veloped or morbidly enlarged, so' that fresh light was thrown upon the function of this gland in respect that its absence of defective development was was accompanied by a considerable alteration of body, and likewise a deficiency of mental gowers. The problem, was attacked from a third point of view. A certain condition of body is known as myxoedema. Briefly stated, in this ailment the bocjily powers fail at large, whilst the face becomes swollen and the skin baggy, the general appearance of the patient presenting somewhat the aspect of a person suffering from dropsy. In addition, the brain-power fails, the person sinking into a state of what may be called mental indolence, and ultimately becoming incapable of effectively governing and controlling his or her life. Here again the mysterious thyroid gland was found to be. involved. Myxoedcma was discovered to bO accompanied by a dis£ns<> In the gland in question. Sush a collection of evidence clearly pointed to the fact that the thyroid gland was to be considered ft highly important organ of OHP feconomy. When its functions are duly investigated, they are found to comprise the manufacture of a secretion which is poured into the blood, and which appears to be essential by way of enabling the vital fluid perfectly to discharge all its functions it) tltc "body. When the thyroid giant! teases to pour this manufacture Into the blood, disease of the nature I have just described begins to be apperent. Now follows the interesting question of medical advance in the Way of cure, knowmg the cause of disease, we are capable of then devising scientific means tor eilre, in place of representing what is known as the empirical practice of medicine; that is, experimenting with this remedy or that, and endeavouring as a m-.'.e result of experience to discover which means is the best calculated to effcet a cure. . pi- Murray, of New-castle-on-Tyne, logically following up what Was known regarding the functions of the thyroid gland, conceived Ulat if the substance of Ihis glhhd taken, say, from the sheep, could be administered to patients, there might naturally fellow improvement and cure. The results of experiments fully justified the expectation. The fV-st treatment of myxoedema was that of injecting the substance of the thyroid gland into the system through the' skin. Later on it was found that if the thyroid substance was administered by the mouth, practically as part of the food, all the good results which follow injection into the skin were obtained, and os to-ttay We find the pharmaeoepbeia contains t-he dry, powedered gland of the sheep, which is duly administered, not merely vi cases of myxoedema- itself, but, likewise for the improvement of cVetinism. It certainly had long bfeih known that persons who wBrB . Suffering from head injuries, Mid who had lost a relatively eoiiarfei-able amount of brain substance, In coiraqconce, frequently recovered, and in many cases did. not" exhibit Bitch marked failure of the mental povrtts as might h-ve been expected when regard was had t-i the Severity of the accidents As a raatt-ir of fact, the brain itself is not an extremely sensitive organ, and i head injuries mostly concern the surgeon f from the point of view of the brain-case • itself, ftr.a hot so much of the organ 1 which that case is intended to contain iand protect. Many instanenn are on record in which extremely Severe brain injuries haro been recovered from with J a facility which has surprised even tncdj I cal men. But when Ulo question arose j of surgical interference with the brain, { by way of removing from its substance \ tumors and growths tending to derange i its functions, the matter assumed a [somewhat diff<| ent aspect. In the first place, it Was necessary to note the ( duties of functions performed by difI ferent parts of the brain. This know- . ledge came to us from the researches of '.'various observers ; and to-day, as a result of such investigations, we find the , whole surface of the brain mapped out . with accuracy in respect of the duties . discharged by each pf.i.t of the area. , The functions of the brain being known, it became an easy matter to diagnose or j identify particular symptoms exhibited ; in brain diseases with affection of par- ■ ticular areas of the brain. Twitching? • of certain groups of muscles, for example, are related to the part of the brain which covers thesa muscles, so that if tho surgeon and physician to- ! gether have reason to suspect that any • special area of the brain is involved. ; say through the existence of pressure !of a tumor, the surgeon can to-day 1 safely cut down upon the spot, remove the tumor, and not merely in many ' cases prolong life, but effect an absolute cure of the case. | Even an organ like the heart, which ; might certainly be supposed to lie out- \ side tho sphere of the surgeon, has | now come to be included within his rr.-o- --[ vince. Not tso very long ago a case [ occurred in London where a man stab- - bar] in the heart was taken to hospital. i The wound in the heart was duly sn- ! hired or stitched, and the patient made a perfect recovery. Surgery in ihis case undoubtedly saved the assailant from ; being indicted on the capital charge. i The heart is, of course, a hollow muscle, I and in the case of a wound of this or- ; gan everything must depend' upon the i p: i.ticular part which has been injured. : If a vital part, and one closely coni nected with what we may call the in- | ternal mechanism of the organ, has been j touched, recovery, of course, is im- ' possible ; but where the substance of the I heart itself has alone been affected, ; surgery is enabled to place the patient in a condition favouring recovery and j this notwithstanding the apparently, con- | stant.work of the organ. For example, j last March, a negro, thi'/ty years of | ntje, was trpatod for a wound in the ! heart in New York. To show how an otherwise severe injury may not necessarily be a fatal one, the patient in this aiso walked a certain distance to ! the hospital after being injured, and ! within forty-five minutes was operated ! unon. The wound was on tho left E'de j cf the heart, and the base or upper part of ths hit ventricle. After duo treatment the patient recovered. In another ! c-i.se, reported at a German surgical cmii fursnee, a wound of the heart was suci I -

cess fully treated, the injury being on the i right upper cavity or portion of the j heart. It is related that this wound in the heart was closed by three silk sutures; and, although tho patient suffered from a complication of troubles thereafter, his recovery was perfect, and he was able to follow his trade, which was that of a butcher. Surgeons know that in a certain number of cases where the heart has been injured, patients may recover without any operation at all, this being, of course, due to the fact .that the wound in the heart closes of itsdlf, a result which, again, depends very materially upon the part of the organ affected. More extraordinary still are these accidents in which injuries to the heart have been inflicted by bullets. Here it mjght be assumed that greatsr laceration or destruction of the hec.t substance takes place. Yet many cases are known to military surgeons and others in which perfect recoveries have taken place as the result of efficient surgical treatment. Indeed, individuals are dive to-day who carry about embedded in their hearts bullets which have, so to speak, made themselves somewhat at home, and which have through the won- j ■lerful power.' of accommodation of the ' ■>rgan, remained in the heart, giving little or no trouble. In one recent case I read that a French soldier was wounded in the left side by a ball from a pistol. The bullet was implanted in the left upper chamber or auricle of the heart. At first no serious symptoms were experienced, but ultimately the patient sought relief on account of difficulty of breathing, pain, and other conditions. The heart was photographed by means of the X-rays, when j Ihe bullet was seen on the left side of the heart, near its base. It was fixed in the heart-substance, and moved with [he impulse of the heart. An operation was undertaken, the bullet removed, and the patient made a complete recovery.