The appearances, on dissection, were highly interesting. The left portion of the thyroid, through which the seton had passed, and to which the principal attention had been directed, extended from the ramus of the jaw to the clavicle: the upper edge of the right tumour commenced just below the larynx, and between the two tumours the trachea was very much compressed. This tumour on the right side was found to be only the superior portion of a very much enlarged thyroid gland, which extended completely into the chest behind the first rib, and, altogether, as large as two closed fists, four-fifths of it being in the cavity of the chest. It was divided into two portions by a groove or sulcus, in which lay the arteria innominata, pushed outwards towards the clavicle. The common carotid was displaced laterally, nearly two inches from the trachea; and the subclavian artery very much elevated above the clavicle and first rib. The par vagum passed over the subclavian artery, but the base of the tumour was engaged in the loop of the ramus recurrens; this loop, instead of being closely in contact with the artery, passed round the bottom of the tumour, which was, at the least, two inches and a half below; consequently, both the par vagum and the recurrent branch were very much stretched and elongated. The nervus vague was redder than on the other side, but there did not appear any material alteration in its size; the recurrent branch, on the other hand, was smaller, and was almost dissipated in a few minute filamentous threads, which could hardly be traced to the larynx.
I forbear making any remark upon this singular and interesting case. Whether death occurred from mechanical pressure upon the trachea, or from paralysis of the recurrent nerve, or from the joint effect of the two, I do not venture to determine.
