In addition, the history of phthisis includes a higher thermometrical record, frequent hæmoptysis, and abundant sputa. Physical diagnosis in cases of phthisis reveals a destructive process involving extensive areas of pulmonary tissue in a comparatively regular sequence. The cancerous process is more local or involves the tissues in an irregular order. Moreover, the asphyxial hue and the pressure-symptoms preponderate in malignant disease. To distinguish the cancerous process from simple forms of bronchitis we may observe the frequency with which the symptoms of bronchitis recur in cancer without exposure to an adequate cause; by the absence of marked tendency to hypertrophic emphysema; by the resistance to treatment; by the persistence of dyspnoea as a prominent symptom; and by the gradual development of patches of hypostatic congestion. To differentiate from aneurism we should consider the occupation of the patient, the absence of syphilis or other causes of arterial disease, the history, the location of the tumor, and the absence of the murmur. Hydatid cysts may simulate cancer, but this disease is rare in America. (Vide [PULMONARY HYDATIDS].) In cancer of the liver, as that organ enlarges pulmonary symptoms may occur from irritation, and congestion or oedema be produced. We must be content to mention the possibility of error, and decide in each case after a crucial analysis of the abdominal or thoracic symptoms.
PROGNOSIS; TREATMENT.—The prognosis is fatal; the treatment purely palliative. It is quite justifiable to relieve pain by the hypodermic use of morphia, cough by chloral or the usual narcotics, and fetor of the breath may be palliated by inhalation of carbolic acid or other disinfectants. Dyspnoea may be alleviated by the use of strychnia as a respiratory stimulant—by inhalation of nitrate of amyl or small allowances of chloroform or digitalis. Paracentesis thoracis must often be resorted to in cases of pleural effusion, even although the relief it affords be temporary.
PULMONARY HYDATIDS.
BY EDWARD T. BRUEN, M.D.
DEFINITION.—A disease in the lungs consequent upon the entrance into the human system of the eggs of a small tape-worm, whose usual habitat is the upper half of the small intestine of the dog.
SYNONYMS.—Tænia echinococcus; Acephalocyst. Fr. Kystes hydatiques du poumon; Ger. Lungenechinococcus.
HISTORY.—Unmistakable references to this disease are found in the writings of Hippocrates, Aretæus, Galen, and other early writers. For a long time, however, the animal character of the hydatid cyst was not recognized, but confounded with slowly-developed local dropsies of various orders and with lymphatic dilatations. Their animal nature was suspected by Hartman in 1685, but their origin was not separated from the cysticercus. In 1766, Pallas clearly distinguished the two species, and this author was followed in a more positive way by Groeze in 1782. Laennec in 1804 carefully studied the hydatid cyst as found in the sheep, recognizing even the mode of reproduction, but he erroneously described the same parasite, when existing in man, as a distinct animal, which he termed acephalocyst. Since 1821, Bremsen, Davaine, Küchenmeister, and others have definitely settled the true mode of the entrance of the Tænia echinococcus into the human system, and the subsequent development of the hydatid cysts. The development of the parasite resembles that of the cysticercus. Like the latter, the larvæ infest the bowels of certain animals, and take their further development in a different animal or species, forming vesicles which are distributed in the parenchyma of the different organs, and in this way more or less seriously compromising the functional life of the part in which they occur.