Diseases of metabolism and of the blood : animal parasites, toxicology / edited by Richard C. Cabot.

Date:
1906
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of metabolism and of the blood : animal parasites, toxicology / edited by Richard C. Cabot. Source: Wellcome Collection.

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    by decided pain and rapid loss of strength. Differentiation between hepatic abscess and a suppurating echinococcus cyst is frequently very difficult. Neither is differentiation between a cyst and a soft cancer nodule easy, for such nodules may frequently produce the signs of fluctuation. Confusion with dropsy of the gall-bladder may readily be avoided, as its position remote from the liver, the form of the tumor, and the anemia will point out the correct diagnosis. The oval form of hydronephrosis, the immobility in respiration, its posi- tion in relation to the colon, palpation in the knee-elbow position, and an examination of the urine will prevent us from confounding echinococcus with hydronephrosis. Multilocular echinococcus also frequently exists for a long time without symptoms, and then the sensation of fulness and heaviness in the epigastrium and stubborn jaundice appear. Bulging in the hepatic region constantly in- creases as the result of the decided enlargement of the organ. Palpation reveals a tumor of hard consistence like cartilage; the surface is smooth and nodulated. Fluctuation at first is limited to individual parts. The spleen is usually enlarged. Nutrition gradually suffers; ascites, anasarca and at- tacks of fever occur. Death results after one or several years, accompanied by the symptoms of marasmus. In form and size, and in the hardness of the liver, multilocular echinococcus resembles hepatic cancer. But the course of the disease is slower, and nutritive disturbances develop only in the advanced stages. Syphilis of the liver pre- sents other forms and degrees of enlargement. The chills and marked jaun- dice which usually occur in abscess of the liver will differentiate this affection from multilocular echinococeus. Hepatic cirrhosis and amyloid liver will, as a rule, be easily differentiated from the hydatid. The prognosis has usually been considered absolutely unfavorable. We have already called attention to the results recently obtained by operation. Echinococcus of the pancreas has been described by Subboitic, Pericic and Salis. Echinococcus of the spleen is rare; according to the Pomeranian statistics it occurred in 4 per cent. of the cases, in the Mecklenburg statistics in only 1.96 per cent. The parasite finds a favorable medium for its growth in the soft splenic tissue. In the main, the symptoms of splenic echinococcus resem- ble those of hepatic echinococcus, but with the difference that the formation of tumor is only upon the left side. Splenic echinococcus is not rarely com- plicated by echinococcus of other organs. Echinococcus of the kidney, which in the Mecklenburg statistics consti- tutes 3.5 per cent. of the cases, and in the Pomeranian 4.58 per cent., usually develops in the cortical substance. Renal echinococci for the most part are unilateral. As it grows all parts of the kidney may be implicated in the disease, and the kidney be transformed into a large echinococcus cyst. This cyst extends into the abdominal cavity, and leads to dislocations and to adhe- sions to neighboring organs. Diseases of the most varied kind may thus be simulated. Small tumors produce no symptoms; larger ones cause pressure phenomena, difficulty in respiration, ete. After years the symptoms of maras-