Hydatid disease in New Zealand / by R. Gordon MacDonald.

Date:
[1889]
Catalogue details

Licence: Public Domain Mark

Credit: Hydatid disease in New Zealand / by R. Gordon MacDonald. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    pain, pulsation, and the bellows murmur distinguishes it from aneurism. Pulmonary hydatids may be divided into two classes—viz., ruptured and unruptured sacs. In the first class the nature of the disease can easily be ascertained by examining the sputum microscopically. In the second the diagnosis is much more difficult. Speaking generally, the symptoms are dulness (more or less absolute) over a certain limited area, usually presenting a rounded outline, and uninfluenced by the position of the patient; absence of the vocal fremitus, or, if any, only a feeble respiratory murmur is present; signs of pressure, as is shown by the tendency to displacement of the neighbouring organs, and deficiency of expansion. Of course it must be remembered that all those symptoms are only relative according to the size and position of the sac or sacs. Trousseau attaches considerable importance to a peculiar arching of the thorax, but in the cases observed here, there has been little information derived from external appearances. The following were the signs in two typical cases which lately came under my notice:—Slight cough and feeling of fullness in the chest; little or no expectoration; can't lie as comfortable as usual on the affected side ; general health very good ; external appearances, nil; respiratory murmur absent over a roundish, limited area ; at the outer edge of this space a few moist rales are heard on deep inspiration; and in the other case, tubular breathing; beyond this, the lung is normal. Percussion reveals complete dullness over a small space, and gradually passing to normal; expansion complete in one and slightly interfered with in the other; no displacement of any organs; date of infection six months prior to examination. The mode of infection was pretty certain in both cases. In the case of multiple hydatids already referred to, all the signs of phthisis were present—flattening of chest walls, sweating, wasting, clubbing of nails, purulent expectoration, &c, but no tubercular bacilli. Indeed, it is reasonable to suppose that such cases are sometimes looked upon as genuine phthisis, and the patient left to die from an unrecognised disease. In persons having a tubercular tendency, it is of the utmost importance to them that an early and correct diagnosis should be made, and the reasons are obvious. The whole ques-