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DISEASES OF THE DIGESTIVE APPARATUS. 



In the bones, mainly at the lower maxillary, the echinococcus 

 often produces exuberant tumors ; they have been found in the 

 medullar cavity of the tibia and femur (Perrin, Morot). 



In the pig, echinocooci are not rare in the muscular system; 

 Lemke found eighteen specimens in one pound of the meat. 



Symptoms. They differ according to the affected organs, but 

 as a rule they have nothing characteristic. 



1. Among the principal symptoms of hepatic echinococcosis we 

 must point out digestive troubles, a progressive emaciation and 

 marasmus. On percussion we find a more or less marked increase 

 in the size of the liver (normal dulness upon the right side, on the 

 surface of the last three or four ribs) ; the region of the hypochon- 

 driumis painful to palpation ; the rectal exploration sometimes per- 

 mits us to establish the existence of embossments or even fluctuating 

 tumors upon the surface of the liver. But when the echinococci are 

 not numerous they are not marked by any serious manifestation ; 

 we even possess observations in which the parasites had caused a 

 considerable increase in the volume of the liver without producing 

 any functional disturbance. 



Ordinarily the thermometer does not record the slightest fever ; 

 this symptom appears only with complications, or during the last 

 period of the disease. The opening of the superficial vesicles in the 

 peritoneum may be followed by a fatal peritonitis. 



2. Pulmonary echinococcosis resembling tuberculosis producing 

 symptoms of phthisis: cachexia, the disappearance of the subcu- 

 taneous connective tissue (skin closely adherent to the bones), etc. ; 

 respiration becomes gradually more painful ; the dyspnoea appears 

 suddenly at times when the echinococci exist in large numbers in 

 the two pulmonary lobes; the inspiration is then abrupt, and a 

 weak, hard cough is to be heard. On percussion we find a dull 

 tympanic sound or a bruit to be compared to that ot a cracked pot. 

 On auscultation the vesicular murmur has disappeared from the 

 regions where the modifications of resonance are found ; it is 

 replaced by strange bruits, and according to Harms, by a gurgling 

 noise (which is also produced when compressing a lung containing 

 echinococci, and to which this author attributes a pathognomonic 

 significaance) ; Schmidt also points out a particular metallic sound. 

 If percussion of the chest is somewhat violent the animals try to 

 avoid it and complain ; this manifestation of pain is accentuated 

 Avhen pressure is made upon the last ribs. In most cases there is 



