152 ENTOZOA FOUND IN MAN. 



surface of the liver press forcibly against the dia- 

 phragm, and, indirectly, against the lungs ; the liver 

 also extends lower down than in the healthy con- 

 dition, and may even be felt below the borders of the 

 false ribs. The lung may be pushed up as high as 

 the third, or even the second, rib, without perforation 

 of the diaphragm ; great dyspnoea, and several of the 

 physical signs of effusion into the pleura result from 

 this abnormal condition, and their constant occur- 

 rence accounts for the fact that the majority of such 

 cases have been mistaken, during the life-time of the 

 patient for hydro thorax or pleurisy.^ 



The diagnosis of these tumours must always be 

 very uncertain, but it may be sometimes possible to 

 distiQguish them when symptoms have been observed 

 similar to those which are produced by hydatids 

 situated in the pleura, or at the base of the right 

 lung, and when, in addition, the liver extends lower 

 than usual. In some cases, also, fluctuation or even 

 hydatid-trembhng may be felt below the edges of the 

 inferior ribs, so that the nature of the affection would 

 then be no longer doubtful. 



Cysts which are developed in the part of the 

 liver which is nearest to the lungs occasionally per- 

 forate the diaphragm, either by then* pressure, or as 

 the result of some violent effort of the patient, and 



* As an illustration of the displacement of the thoracic 

 viscera which results from the presence of hydatids in the left 

 hypochondrium, a case may be referred to, in which, owing to the 

 development of a cyst in the spleen, the heart was pushed up as 

 high as the third rib, and the lung, which was scarcely larger 

 than the closed hand, was pressed towards the roots of the 

 bronchi ; the diaphragm, which was considerably raised, was not 

 perforated. 



