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CH. MARCHAND'S PEROXIDE OF HYDROGEN

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(MEDICINAL) H2O2 (ABSOLUTELY HARMLESS.)
MOST POWERFUL BACTERICIDE AND PUS DESTROYER.
ENDORSED BY THE MEDICAL PROFESSION.
UNIFORM IN STRENGTH, PURITY AND STABILITY.
RETAINS GERMICIDAL POWER ANY LENGTH OF TIME.

USED BY THE HOSPITALS OF THE U. S. ARMY.
Send for free book of 88 pages giving articles by the following contributors :

DR. E. R. SQUIBB, of Brooklyn; N. Y., DR. ROBT. T. MORRIS, of N. Y.,
DR. EGBERT H. GRANDIN, of N. Y., DR. JOHN AULDE, Phila., Pa., DR.
W. F. WAUGH, of Phila., Pa., DR. GEO. B. HOPE, of N. Y., DR. E. CHAREST,
o St. Cloud; Minn., DR. G. F. ADAMS, of Pulaski, N. Y., DR. H. F. WIGGIN,
of N. Y., DR. J. A. LARRABEE, of Louisville, Ky., DR. R. M. CHASE, of Bethel, Vt.,
DR. ROBT. T. WILSON, of Baltimore, Md., DR. J. H. SHERMAN, of Boston, Mass.,
DR. C. M. WOODWARD, of Tecumseh, Mich., DR. GEO. H. PIERCE, of Brooklyn,
N. Y., and many others.
NOTE.-Avoid substituter-in shape of the commercial article bottlod-uniit,

unsafe and worthless to use as a medicino.
Ch. Marchand's Peroxide of Hydrogen (Medicinal) is sold only in 4-02.,
8.03., and 16-oz. bottles, bearing a blue label, white letters, red and gold
border, with his signature, Never sold in bulk.

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GLYCOZONE.

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PREVENTS FERMENTATION OF FOOD IN THE STOMACH.
MOST POWERFUL REMEDY FOR HEALING PURPOSES. CURES:
DYSPEPSIA, GASTRITIS, ULCER OF THE STOMACH, HEART-BURN.
Glycozono Is sold only in 4-oz., 8-oz., and 16-oz, bottles. Never sold in bulk.

PHYSICIANS WILLING TO PAY EXPRESS CHARGES WILL RECEIVE FREE SAMPLES ON APPLICATION.

BOTH OF THE ABOVE REMEDIES

ARE PREPARED ONLY BY

Chantes torchands

Mention this publication.

ge
Chemist and Graduate of the Ecole Centrale des Arts et Manufactures de Paris (France).

SOLD DY RADING DRUGGISTS.

Laboratory, 28 Prince St., New York.

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REMOVAL OF CYSTIC GOITRE AND LEFT LOBE OF

THYROID GLAND.*

BY PAUL F. EVE, M.D.,
Professor of Principles of Surgery and Operative and Clinical Surgery

in the Medical Department of the University of Tennessee,

On July 18th I received a hasty summons to come to Grundy County, this State, for the purpose of performing an operation. The case being urgent, I left the next morning and arrived at my destination that afternoon. I met in consultation the attend. ing physicians, Drs. Barnes and Black, and made a careful examination of the patient. He was a man who apparently had once a robust constitution, but which had been severely taxed

*

Reported at Nashville Academy of Medicine August 3, 1893.

Prior to my

by hard labor. He was born in Switzerland, January 18, 1865; thus making him 28 years old at the time of the operation.

Upon examination, a tumor was discovered upon the anterior part of the neck, extending from the hyoid bone to near the sterno-clavicular articulation, and from side to side to the margins of the sterno-cleido-mastoid muscles. The tumor must have been in diameter from five to six inches. In front, palpation gave fluctuation, but upon left side a marked induration could be felt, pushing aside the sheath containing the carotid artery, jugular vein and pneumogastric nerve. The pulsation of carotid could be distinctly seen and felt in this situation. We clearly came to the conclusion that we had to deal with a cystic goitre.

The patient for the past few days was complaining of suffocation, and as this was constantly getting worse, and the tumor growing larger, I was sent for to remove the same. arrival an attempt had been made to evacuate the cyst, but a dry tap was the result.

From the patient we obtained the following history: That up to the time of the appearance of the tumor, which was first noticed June 14, 1893, he had been a steady, robust man, and had always enjoyed the best of health. He was active and had been working very hard for the past two or three years, frequently running his labors late into the night. He also stated that there was scrofula in his family; but, upon closely questioning him, he gave no symptoms of ever having had this affection. The tumor when first noticed by him was about the size of a hickory nut, hard to the touch, but accompanied with no pain. Thinking it was a slight swelling, and that it would go away, he paid but little attention to it and kept right on with his work. Shortly after this first examination he became aware that the tumor was increasing in volume, and, while it gave him no pain, yet it became a source of anxiety. At the request of his wife Dr. Barnes was called to see him. The doctor saw him first about the latter part of June and gave him treatment to relieve the tumor, but to no effect; it rapidly increased in size and volume each day. Dr. Black was now called in consultation, and, as the tumor was giving him great inconvenience by weight, and a slight oppression by night, fluctuation being detected, a trocar and canula was inserted for the purpose of evacuating the fluid,

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but to their disappointment no fluid was drawn off. This operation was performed about July 14, 1883.

Suffocation from pressure of tumor upon trachea was first complained of about four or five days prior to my visit, and this became greatly increased, especially during the night. These symptoms gradually increasing, and fearing death from suffocation, we placed the patient upon preparatory treatment in order to get him in as good condition as possible before operation. I operated upon him July 20, 1893, assisted by Drs. Barnes and Black. A crucial incision was made, the vertical extending from hyoid bone to near the middle of sternal notch, and horizoncal from the margins of sterno-cleido-mastoid muscles, and these flaps dissected back. But little hemorrhage was elicited by this incision. The cyst being now brought prominently into view, was pierced with a trocar and canula, and about eight to eight and a half ounces of bloody fluid drawn off. The cyst was now rapidly dissected off, hemorrhage being controlled by hemostats. My attention was next directed to the left lobe of the thyroid gland, which was enlarged and very hard, and pressing to some extent upon the trachea. This was dissected up moved. The isthmus and right lobe being but slightly enlarged were left intact. All vessels being now secured and ligated, the edges of the incision were approximated and the wound antiseptically dressed.

My patient made a rapid and safe recovery, and since the operation has had no symptoms of suffocation. At this date, August 20th, patient is in excellent condition, and wounds entirely healed.

There are several interesting points about this case that I desire to call attention to. First, goitre or bronchocele is an af. fection common among women, but less frequently occurring among men, and especially in our Southern States. We are aware, however, that it occurs quite frequently in the regions of the Alps, Appenines and Pyrenees, and even occasionally as an epidemic. Now, although our patient was a native of Switzerland, he had been living on the Cumberland Mountains for six or eight years. So, then, we have the rare case of goitre in the male, and occurring in our Southern States.

Secondly, I call attention to the peculiar fluid evacuated.

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This was not serous fluid tinged with blood, but had the characteristic conditions of defibrinated blood, and remained in this condition after being removed.

And, finally, to the mode of the incision made—viz: the crucial instead of the Y or straight incision commonly made. My reason in making this incision was for the purpose of having a clearer field for operation than the others would admit, and thus being better able to grasp the bleeding vessels with hæmostats, and losing as small a quantity of blood as possible, and thereby adding to the chance of the recovery of my patient.

The question of treatment of goitre is still under discussion, and many

and varied are the remedies and methods used. Probably the most approved and efficient medicinal treatment at the present time was that instituted by Dr. Barnes when he first saw the case; viz: the internal administration of iodide of potash and strychnia and the external application of iodine. Under this treatment conjoined by the application of galvanism I have seen several enlargements diminish and some even disappear, especially those in young females between the ages of sixteen and twentyfour, but as stated above, this gave but little or no relief to our patient. Another method extolled by many is in the evacuation of the cyst, and then the injection into the sac of tinc. iodine, solutions of carbolic acid, tinct. chloride of iron, solution of ergot, etc. But these interstitial injections are not devoid of danger and have produced death by entrance of air into the venous circulation or by the production of thrombus and embolism. Again, violent inflammation has occurred, and sloughing and gangrene supervened, leaving the patient in a worse condition than prior to the operation. We find, also, that in a number of cases that they have produced but little or no good, and the cyst had developed again, requiring operative procedure. Now, I mention this treatment only to condemn it, and infinitely prefer the chances of an operation to the chances of such methods of treatment. I may mention also the treatment by galvanism, which,

. in my bands, together with the multiple puncture, has resulted in several cases of complete recovery and disappearance of the tumor, and which I think ought always to be tried when the nature of the case admits of it.

All these lines of treatment I have suggested from the fact

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