In hydatids of the liver: an incision over the most prominent part of the mass should be made, if a 11141,z, can be de tected; but, if no tumor is obvious, the guide to incision is the area of hardening and of dullne.ss on percussion. They should he produced by suturing he peri toneum around the mass. The aspirator is used to prove dia,gnosis, always bear ing. in mind the possibility that typical fluid will not appear, (IS it may be too thick to enter the needle. When it has been found necessary to produce adhe sions artificially the surgeon waits for several days before opening the cyst. The opening made in the cyst-wall should be of stifficient size to admit a large-sized drainage-tube. The dressing must be conducted with the strictest antiseptic care. For the first week after operation the cyst-cavity should be washed out with sterile water, after this with ear liolic solution, iodine solution, or any of the antiseptic solutions. J. Frank (Amer. Jour. Med. Sci., Oct., '96).
In resection of the liver for echinocoe cus stress laid on the value of a prelimi nary ligature passed through the whole substance of the liver, so as to keep the organ well in the abdominal wound. Pal leroni (Gazz. clegli Osped., Aug. 7, '9S).
Case of hydatid cyst of the liver and a case of abscess of the liver, both of which were treated by transpleural drainage, a portion of the ninth rib hav ing been removed. In order to shut off the pleural cavity the cyst in the first patient was sutured to the tissues of the chest-wall, and in the second patient the sante result was achieved by the suturing of the viscera to the parietal layer of the pleura. Both patients re covered. Newbolt (Brit. Med. Jour., Jan. 24, 1903).
Free incision and drainage are being resorted to more frequently of late, and with results that justify such radical means.
Electrolysis and potassium iodide have been successful in a few cases.
Amyloid Liver.
Symptoms.—There are no characteris tic symptoms of amyloid liver. The pa tient presents the symptoms of the pri mary disease to which the amyloid change is due. IIe is pale, cachectic, and later may be dropsical. There is no jaundice or bile-pigment in the urine. Bile is secreted and flows into the in testines, coloring the contents. There is disturbance of digestion and often diar rhcea, on account of the amyloid deposit in the intestine. The urine is usually copious, pale, of low specific gravity, and contains much albumin on account of the amyloid disease of the kidneys.
On physical examination the liver is found large, firm, smooth, and not ten der. Its lower edge is usually rounded,
but sometimes sharp, and not rarely as low as the iliac crest. There are no signs of portal obstruction. The spleen may be large, on account, chiefly, of the amy loid change in it.
Course and Duration. — The general condition grows gradually worse, the sur face becomes an earthy pallor, which, some believe, is characteristic, and the patient dies from exhaustion, if not cut off by an intercurrent affection or a "ter minal infection." The duration of the disease is -usually several years, although occasional cases run their course in a few months.
Diagnosis.—This is usually easy from the associated conditions. The occur rence of progressive enlargement of the liver in a case of long-standing suppura tion, especially of a tuberculous or syphi litic character, renders the diagnosis al most certain. The co-existence of de generation of tim kidneys, spleen, and intestines adds to the certainty of the diagnosis.
Etiology.—In amyloid liver a deposit of waxy material takes place in the blood-vessels and interstitial tissue of the liver. It occurs as part of a general de generation in certain constitutional con (litions of which prolonged tuberculous suppurations of the bones, lungs, and urinary tract are the most frequent. Next to these, syphilitic suppurations are the most common causes; but the amy loid change may occur in syphilis with out suppuration. It is also occasionally found in rickets, Bright's disease, leu kmmia, malignant disease, and in pro tracted convulsions from infectious fevers.
Morbid Anatomy.—In advanced sta,ges the liver is greatly and uniformly en larged. Its size may be doubled and its weight more than trebled. The surface is smooth, firm, and of a slightly glisten ing yellowish-gray color. On section the surface has an anmmic, waxy appearance, is semitranslucent in thin sections, and the infiltrated areas stain a rich mahog any-brown on the application of a dilute solution of iodine, while the normal parts become a light yellow.
The morbid change usually affects the capillaries in the middle zone of the hepatic lobules first, and later the inter lobular vessels and connective tissue. In the capillaries "the amyloid substance lies between the endothelium and the liver-cells, and the latter atrophy appar ently because of the pressure which the arriyloid substance exerts. Some of the cells show fatty and albuminous degener ation" (Thoma).