Volume 2

Differential diagnosis / by Richard C. Cabot.

  • Cabot, Richard C. (Richard Clarke), 1868-1939
Date:
[between 1920 and 1929]
Catalogue details

Licence: In copyright

Credit: Differential diagnosis / by Richard C. Cabot. Source: Wellcome Collection.

    143/732 (page 133)
    *33 Supposing that we were correct in our belief that a nodular enlarge¬ ment of the liver existed, there are really but three reasonable possi¬ bilities: first, malignant disease; second, syphilis; third, hydatid. The patient is extraordinarily young for cancer of the liver. He has had no gastric symptoms such as usually accompany the primary gastric cancer, from which the liver metastases follow. Moreover, this patient s nutrition is extraordinarily good for so serious a neo¬ plasm. Syphilis cannot be excluded and the absence of a Wassermann reaction does not rule it out. We cannot say, however, that we have any positive evidence of such disease unless the presence of an accom¬ panying splenic tumor is so regarded. Hydatid is suggested by the patient’s race and by his good nutri¬ tion, despite the presence of a large tumor. Against it we have the lack of any eosinophilia and the general rarity of the disease in New England. We have almost ceased to look for the classical hydatid thrill about which the older text-books used to excite us so much. Outcome. Operation showed a liver studded with cysts, whence scolices were obtained. In view of all the facts and of the patient’s good recovery, there seems no good reason to believe that there is any disease in the kidney or in the region of the prostate. The findings recorded in these organs are regarded as errors.