OBSTETRICS.
The Bronchocele of New-born Infants.—Dr. Betz, of Tubingen, has
published an interesting essay upon this subject. He attributes the si-
lence of authors respecting it rather to their having overlooked the affec-
tion than to its rarity. Such children are usually stout and full-blooded,
and the enlarged thyroid may.be mistaken for a mere fold of fatty integ-
ument. In some, the neck seems merely too broad, while in others it
undergoes no change ; these differences depending upon the part of the
gland engaged.
Immediately, or very soon after birth, a marked difficulty of respira-
tion comes on, which may prove fatal in a few hours, or in two or three
days only. The inspirations are deep, being accompanied by a pecu-
liar croaking tone, that may be heard outside the door. The expiration
is also very laboured and sometimes accompanied by a cry. At times
the breathing seems quite arrested, so that the child is in the most ex-
treme danger from suffocation, until, with a cry, inspiration again oc-
curs. The dyspnoea is sometimes irregularly paroxysmal. The alae
nasi are usually expanded, and the lips and hands of a blue color.
Sucking is impossible, and attempts produce the most extreme dyspnoea,
which is also excited if the child be fed, the greatest difficulty prevail-
ing in getting it to swallow the least quantity. The mouth is full of
saliva and mucus, which collect in small bladders between the lips.
According to the amount of disease, the remissions are longer or short-
er, and the child sometimes at last goes off quite unexpectedly.
The affection consists in a simple hypertrophy of the thyroid ; no
change in its normal structure, save perhaps some increase in its vascu-
larity, being observable. The whole gland may be affected, giving a
crescent shape, and, where an isthmus connects the two lobes, the neck
assumes a g|eat breadth. In other cases only one lobe, or even only
the apex of'that, may be affected, and the nature of the disease be un-
detected. The passage to the larynx and trachea is more or less im-
peded, while the posterior developments of the tumour impedes swal-
lowing, and endangers suffocation in the attempt. The accumulation
of mucus is an additional cause of obstruction. It is not merely the
size of the swelling of the lobes, but its position, that determines the
amount of danger.
The affection would seem sometimes to be hereditary, or, at all events,
it affects several members of the same family. Various friends of Dr.
Betz have observed this bronchocele of infants, but he is not disposed
to consider it as especially endemic at Tubingen. He thinks that the
suffocative dyspnoea, and death resulting from this disease, may eluci-
date the nature of some of the cases of laryngeal asthma, spasm of the
glottis, thymic asthma, or laryngismus, concerning which so much con-
fusion and doubt at present prevails. An enlargement of the thymus
may certainly co-exist with one of the thyroid, but this last affords a
much more rational explanation of the symptoms. Thymic enlarge-
ment may induce dyspnoea, but not the laryngeal disturbance. Atelec-
tasis, too, the author believes, is often due to the impediment caused by
this enlarged thyroid.
In a disease so rapid in its progress, little time remains fortreatment;
but, where this is obtainable, leeches should be applied, and an eme-
tic given. Where the hypertrophy is less considerable, and the disease
more prolonged, the internal and external use of iodine would be deser-
ving of a trial.—London Med. Times, from Henle and Pfeufer’s
Zeitschrift.