This perihepatitis is indicated by exceptional sensitiveness in the right hypochondriac region, and by respiratory disturbance due to fixation of the diaphragm.
In certain cases these abscesses seem to develop like “cold” abscesses—i.e., without fever, and this without producing very marked digestive disturbance; but the patients waste rapidly, become weak, show slight sub-icteric coloration of the membranes, and appear to lose their strength. Movement is slow and hesitating, as though the animals were suffering from laminitis, the anæmia becomes more marked from day to day, and examination of the blood reveals abundant leucocytosis, the existence of which often assists in the diagnosis of internal suppuration. In a few months, at least in the cases we have seen, the animals become cachectic.
In other and still more obscure cases suppuration of the liver is accompanied by total hypertrophy, excessive sensitiveness in the right hypochondriac region, progressive loss of appetite, excessive thirst, and uncontrollable diarrhœa and fever, although in the case mentioned above there was little fever and no diarrhœa. The course of these cases, which probably result from intestinal infection, is much more rapid. In a fortnight or three weeks, sometimes less, the patients are carried off by intoxication, generalised purulent infection, or septicæmia.
Diagnosis. The diagnosis of suppurative echinococcosis and of primary abscess of the liver is difficult to establish. It is attained chiefly by a process of exclusion, though the signs furnished by percussion of the right flank, and by examination of the blood, are of some assistance.
Fig. 134.—Thin-necked bladder-worm (Cysticercus tenuicollis), with head extruded from body, from cavity of a steer, natural size. (Stiles, Annual Report, U.S.A. Bureau of Agriculture, 1901.)
Fig. 135.—The marginate tapeworm (Tænia marginata), natural size. (Stiles, Annual Report, U.S.A. Bureau of Agriculture, 1901.)
Prognosis. The prognosis is extremely grave.
Treatment is of little value. Even supposing that the diagnosis has been exact, surgical intervention is out of the question, and only this would appear theoretically to offer a chance of success. The abscesses are multiple, deeply placed, separated from one another, and sometimes surrounded by enormous tracts of inflamed tissue. In fact, the condition is of such a character as entirely to prohibit active measures.