and, not larger
that a hen's egg, will do more damage to the trachea than will a large
tumor, such as that shown by Senn, after Bruns. When a tumor has
attained this size, pressure-symptoms are often relieved by the weight
of the tumor making traction away from the trachea. Goiter is endemic
in some countries, particularly in Switzerland and Austria, and appears
particularly at the age of childhood or of puberty. Some communities in
this country using water containing an excess of calcium salt show
distinct evidences of endemic goiter. Extirpation of the thyroid gland
has in recent years been successfully practiced. Warren has extirpated
one lobe of the thyroid after preliminary ligation of the common
carotid on the same side. Green practiced rapid removal of the tumor
and ligated the bleeding vessels later. Rose tied each vessel before
cutting, proceeding slowly. Senn remarks that in 1878 he witnessed one
of Rose's operations which lasted for four hours. Although the operatic
technic of removal of the thyroid gland for tumor has been greatly
perfected by Billroth, Lucke, Julliard, Reverdin, Socin, Kocher, and
others, the current opinion at the present day seems to be that
complete extirpation of the thyroid gland, except for malignant
disease, is unjustifiable. Partial extirpation of the thyroid gland is
still practiced; and Wolfler has revived the operation of ligating the
thyroid arteries in the treatment of tumors of the thyroid gland.

Fibromata.--One of the commonest seats of fibroma is the skin.
Multiple fibromata of the skin sometimes occur in enormous numbers and
cover the whole surface of the body; they are often accompanied by
pendulous tumors of enormous size. Virchow called such tumors fibroma
molluscum. Figure 237 represents a case of multiple fibromata of the
skin shown by Octerlony. Pode mentions a somewhat similar case in a man
of fifty-six, under the care of Thom. The man was pale and emaciated,
with anxious expression, complaining of a tumor which he described as a
"wishing-mark." On examination he was found to be covered with a number
of small tumors, ranging in size from that of a small orange to that of
a pin's head; from the thoracic wall over the lower true ribs of the
right side was situated a large pendulous tumor, which hung down as far
as the upper third of the thigh. He said that it had always been as
long as this, but had lately become thicker, and two months previously
the skin over the lo