This section is from the book "The London Medical Dictionary", by Bartholomew Parr. Also available from Amazon: London Medical Dictionary.
(From
the wind pipe, and
tumour). Also called bocium, botium. It hath various names in different writings; the Swiss call it gotre; some have called it hernia gutturis, gutter, tumi-dum, et trachelophyma, gossum, exechebronchos; gon-grona, hernia bronchialis: Heister thought it should be named tracheocele. Mr. Prosser, in his late publication on this disorder, from its frequency on the hilly parts of Derbyshire, calls it, with others, the Derbyshire keck; and, not satisfied respecting the similitude of this tumour with that observed on the neck of women on the Alps, the English bronchocele. As various causes give rise to this complaint, he endeavours more strictly to distinguish that in which he expects success in his attempt to cure. When not produced by accidents, such as loud speaking, crying, blows, he calls it the natural, the spontaneous, or the curable bronchocele.
The seat of this disease is the thyroid gland, which Dr. Hunter hath observed lies just below the larynx, round the trachea. The tumour appears in the fore part of the neck, between the skin and the wind pipe. Women are the most frequent subjects of it, and in them it usually appears early. Dr. Hunter met with one case of this kind in a young surgeon; but it rarely happens in males.
Various causes are assigned by different writers. On the mountainous parts of Genoa and Piedmont, they attribute these tumours to drinking water cooled with ice. Dr. Leake thinks it very probable that such glandular swellings as happen about the neck and face, may be owing to the severity of the cold moist air, especially since they generally appear in winter, and rarely in the warm dry climates of Italy and Portugal. This, he adds, is probable, because the intense degree of cold may constringe the glandular ducts, and lock up that fluid which ought to pass freely through them. borne writers attribute it to a scrofulous cause. Mr. Prosser inclines to think that it is a dropsy in the gland, and similar to the dropsy in the ovaries. He relates, that Dr. Hunter dissected one of these glands that had been considerably enlarged, and it was found to be distended by a number of cysts filled with water, which must have been hydatids. Yet most writers agree that its true cause and nature are alike unknown.
The bronchocele, Mr. Prosser observes, is a tumour arising on the fore part of the neck; it generally first appears some time betwixt the age of eight and twelve years, and continues gradually to increase for three, four, or five years; and sometimes the last half year, we are told, it grows more than for a year or two before. It generally occupies all the front of the neck, for the whole thyroid gland is enlarged; but it does not rise near so high as the ears, as in the cases mentioned by Wiseman; and it is rather in a pendulous form, not unlike, as Albucasis says, the flap or dewlap of a turkey-rock, the bottom being the larger part of the tumour. In figure, it varies considerably in different cases. It is soft, or rather flabby to the touch, and somewhat moveable; but, when it has continued some years after it has ceased to increase, it becomes more firm or confined. By the situation and nature of the complaint, it generally occasions a difficulty of breathing, which is increased on the patient's taking cold, or attempting to run. In some the tumour is so large, and so much affects the breathing, as to occasion a loud wheezing; but we meet with many exceptions to this general rule. When large,patients sometimes suffer but little; others suffer much from an inconsiderable tumour. In general, however, it occasions little inconvenience. Dr. Hunter observed, that this tumour now and then suppurates.
The bronchocele should be distinguished from a scirrhus, from an aneurism, and from those swellings in the neck that arise from strains or ruptured vessels. The distinction, however, is not difficult.
This tumour never, becomes cancerous. Mr. Gooch says, he never knew this tumour, however large, to endanger life; but he observes a considerable inconvenience from it in cases of quinsy combined with it. Mr. Sharpe mentions, that the only cases of quinsy requiring bronchotomy, were owing to the presence of bron-choceles. Dr. Hunter has observed, that this disorder appears two or three years before or after menstruating; and that it sometimes spontaneously disappears, if the menstruation approaches kindly. Mr. Prosser thinks that this change in the constitution scarcely ever affects the tumour. We have never found that it has produced any diminution of its bulk.
The drain of an issue, or of a perpetual blister, applied on some other occasions, has apparently prevented the growth of the bronchocele, though the effect continued only during the drain. It cannot be extirpated, as it is entangled with the recurrent nerves, and the first branch of the external carotid artery; and if by chance a suppuration is formed, an ill conditioned ulcer, difficultly cured, is the consequence. Mr. Prosser hath succeeded, in many instances, in discussing it. On this plan, the late famous Coventry practice was formed, which Mr. Wilmer has inserted in an Appendix to his Cases in Surgery. It begins with an emetic the day after the moon is at the full, and, the day after that, a purge is given; the night following, and seven nights successively, the following bolus is laid under the tongue at bed time; and, in the days, a bitter stomachic powder given at noon. On the eighth day the purge is to be repeated; and, in the wane of the succeeding moon, the whole process to be repeated, except the emetic. The tartar emetic ointment rubbed in on the tumour is supposed to assist the cure; and, indeed, by-adding this application to the Coventry receipt, we have often succeeded in greatly reducing bronchocele. Mr. Xing gives the burnt sponge in the dose of a scruple three times a day; but, if his recipe be correct, two ounces of the sponge in twenty-four troches must amount to two scruples in each. He attributes the cure to the quantity, which,we think, with many stomachs would be inconvenient. The lozenge to be laid under the tongue is formed of calcined sponge, cork, and pumice stone, of each ten grains, syrup a sufficient quantity.
Mr. Prosser has succeeded by the use of his medicines, though the patient was nearly advanced to her twenty-fifth year, more than twelve years after the appearance of the tumour on the neck: after the twenty-fifth year, no instance of success hath occurred. He orders one of the following powders to be taken early in the morning, an hour or two before breakfast, and at five or six oclock in the evening, every day for a fortnight or three weeks. The powder may be taken in a little syrup, or sugar and water, or any thing else, so that none may be lost. If it does not sit well on an empty stomach, it may be taken betwixt breakfast and dinner.
Cinnab. ant. op. levigat. milleped. ppt. et pulv aa gr. xv. Spong. calcinat. Э i. m.
These powders should be taken for two or three weeks, then omitted for about a week or nine days; the same course must be then repeated. 002 night, during the second course of the powders, three of the following pills are to be taken:
. Hydrargyr. 3 v. terebinthinae Strasburgensis 3 ij-extracti colocynthidis comp. Э iv. pulv. rhabarbari 3 i.
First grind the quicksilver with the turpentine till it appears no longer, then add the rest, and form a mass. if the turpentine be too thick, a little olive oil must be added.
These medicines do not require confinement, except they are taken in severe weather, and then only to the house; nor need the diet be much regarded. It may be sufficient that the medicines are taken in a temperate season, or rather warm weather, and the patient lives exactly in the usual way, guarding against cold during the second course of the medicines. The patient, if a servant, should avoid standing, especially at the washing tub, or any work with cold water. As to diet, when no alteration hath been made in it, the success has been the same as when stated regulations were regarded. In this discretion may occasionally direct. If the pills continue to purge, after taking them a few days, it would be better to leave out the extr. coloc. comp. in their preparation, and lessen the dose in the same proportion. In general it will be proper for the patient to be purged twice or thrice with manna and salts, or any gentle cathartic, before the powders are begun. The medicines are here proportioned for an adult of a good constitution; therefore, if the patient is younger, or of a weakly habit, the doses must be managed accordingly. As to external applications, they may be hurtful, but do not appear likely to be useful.
The patient must not expect to find benefit in a little time; perhaps it will be as long after the medicines are all taken, as the time they are in taking, before much difference will be perceived in the tumour of the neck. It is necessary that the medicines be begun at a proper time, especially the second course; a few days should always be dispensed with on that account.
Amongst the earlier writers, Albucasis is the first who gives any useful account of this disorder. See it translated into Friend's Hist, of Physic, and into James's Med. Dict. art. Bronchocele. Sec also Turner's Surgery, vol. i. p. 164. Wilmer's Cases and Remarks in Surgery, in the Appendix. An Account of the Method of Cure of the Bronchocele, by Thomas Prosser, edit. 3. Gooch, in his Med. Obs. gives an instance of an aqueous bronchocele. Bell's Surgery, vol. v. 514. White's Surgery, 289. Memoirs of the Medical Society of London,217.
 
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