700 DISEASES OF THE LIVER. 



Fame time, the right half of the thorax may be dilated, the lower ribs 

 being moved upward and outward. On palpation we may still more 

 distinctly recognize the enlargement of the liver, and the inequality of 

 its surface. The protuberances appear more yielding than those due 

 to the softest forms of cancer. Occasionally there is distinct fluctua- 

 tion. The percussion-sound is absolutely dull all over the enlarged 

 liver. On percussing over the hydatid itself, in some cases we notice 

 a peculiar thrill (Piorry's Fr6missement hydatique), similar to that 

 obtained by striking on tolerably stiff glue. 



Among the symptoms of the termination of the disease, those of 

 the gradual atrophy of the sac cannot be given, as this termination 

 only occurs in small hydatids which cannot be diagnosed. If the 

 hydatid burst into the peritoneal sac, we have the same symptoms 

 as in perforation of ulcers of the the stomach. If the hydatids 

 were not previously diagnosed, we cannot tell what substance 

 has entered the peritonaeum. The patients die in a few days of the 

 rapidly-fatal peritonitis. We can only recognize perforation into the 

 stomach, intestines, or lung, when portions of the hydatid are vomited, 

 evacuated at stool, or coughed up. If the echinococcus vesicle excite 

 inflammation in its vicinity, the enlargement of the liver, previously 

 free from pain, now becomes very painful, and is especially very sen- 

 sitive to pressure. There are chills and high fever, and we have the 

 picture of suppurative hepatitis, and its results, which were described 

 in Chapter II. If the abscess of the liver perforate externally, we 

 may occasionally find traces of the peculiar laminated membrane, or 

 some of the hooks of the hydatid in the pus. 



TREATMENT. Fomentations of strong solutions of common salt 

 Dver the region of the liver have been recommended for hydatids of 

 that organ, and Sudd says that, from the peculiar attraction and affin- 

 ity of the hydatid cyst for salt, it is possible that the collection of the 

 latter in the fluid thus effected may prevent the further development 

 of the echinococcus, or destroy it altogether. Others recommend prep- 

 arations of iodine and mercurials, on account of their known w anti- 

 parasitic " effect, and anthelmintics are used for the same reason. 

 These remedies deserve little confidence, as they have been advised on 

 theoretical grounds, and not from actual experience. If we conclude 

 to use them, we should at least choose those least injurious to the 

 organism. In Iceland they appear to open hydatids boldly ; in this 

 country very bad results have occurred from opening them without 

 precaution ; and, when we decide on puncturing them, the same rules 

 are necessary as in opening abscesses of the liver. 



