SUPPURATIVE ECHINOCOCCOSIS. 289 



vesicles is less regular ; they may become accidentally infected and 

 transformed into encysted abscesses, constituting suppurative echino- 

 coccosis of the liver. The membrane of the vesicles usually resists the 

 passage of microbes, but the fibrous tissue surrounding the cyst is very 

 vascular ; and if, in consequence of vascular disturbance in the liver 

 (which may result simply from feeding, trifling infection or other visceral 

 disease), the blood should for a short time be infected, microbes pene- 

 trate through solutions of continuity in the wall of the vesicle, which 

 becomes a centre of suppuration. The liquid becomes turbid, the primary 

 cyst is transformed into an abscess, and suppurative echinococcosis is 

 set up. 



Symptoms. The general condition resulting from the development 

 of suppuration in echinococcus cysts is very different from that of true 

 echinococcosis. If the abscess develops rapidly, acute generalised peri- 

 tonitis or localised peritonitis of the right anterior abdominal region 

 may almost immediately occur, i^roducing all the characteristic symptoms 

 of ordinary peritonitis. In all cases, even in the absence of well-marked 

 peritonitis, perihepatitis occurs, and the liver becomes adherent to the 

 posterior surface of the diaphragm, to the hypochondriac region, to the 

 abdominal wall, or to one of the gastric compartments. 



This perihepatitis is indicated by exceptional sensitiveness in the right 

 h}7)ochondriac region, and by respiratory disturbance due to fixation of 

 the diaphragm. 



In certain cases these abscesses seem to develop like " cold " abscesses 

 — i.e., without fever, and this without producing ver}^ marked digestive 

 disturbance; but the patients waste rapidly, become weak, show slight 

 subicteric coloration of the membranes, and appear to lose their 

 strength. Movement is slow and hesitating, as though the animals 

 were suffering from laminitis, the anaemia becomes more marked from 

 day to day, and examination of the blood reveals abundant leucocytosis, 

 the existence of which often assists in the diagnosis of internal suppura- 

 tion. In a few months, at least in the cases we have seen, the animals 

 become cachectic. 



In other and still more obscure cases suppuration of the liver is 

 accompanied by total hypertrophy, excessive sensitiveness in the right 

 hypochondriac region, progressive loss of appetite, excessive thu-st, and 

 uncontrollable diarrhoea and fever, although in the case mentioned above 

 there was little fever and no diarrhoea. The course of these cases, which 

 probably result from intestinal infection, is much more rapid. In a 

 fortnight or three weeks, sometimes less, the patients are carrieo off by 

 intoxication, generalised purulent infection, or septicaemia. 



Diagnosis. The diagnosis of suppurative echinococcosis and of 

 primary abscess of the liver is difficult to establish. It is attained 

 D.c. U 



