224 ANIMAL PARASITES. 



when perforation takes place into the intestines. If we employ 

 auscultation and percussion simultaneously 011 this spot, we may 

 also probably succeed, if the perforation be narrow, in hearing the 

 air escape through this opening into the intestine with a whistling 

 or hissing sound. Similar results may also be produced by a 

 perforation of the Echinococcus-colony in the direction of the 

 bladder, in consequence of the entrance of the atmospheric air 

 into the sac of the Echinococcus through the urethra. In case 

 of the perforation of an Echinococcus -colony of the liver into the 

 lungs, or of the lungs themselves into one of their bronchi, 

 the clear drum-like percussion-tone w^hich takes the place of the 

 previous dull tone, will guide us in the establishment of our diagno- 

 sis, and we shall be further assisted by combined auscultation 

 and percussion by the signs just described ; and lastly, by simple 

 auscultation, the whistling entrance of the air into the Echino- 

 coccus-sac, and the amphoric noise of respiration diffused through 

 the sac, or, when there is free fluid in the sac, even associated 

 more or less with a formation of bladders (either large or small). 



When such a perforation has not taken place of itself, but we 

 have before us a tumour of considerable size (recognisable by 

 percussion or palpation), and especially when there is a sensa- 

 tion of fluctuation, when aneurismal symptoms are wanting, 

 and the general health is good and less injured than would be 

 expected from the size of the tumour in cancer, the diagnosis is 

 best formed by an explorative puncture, and the microscopic 

 examination of the evacuated fluid for Echmococcus-scolices, or for 

 the albuminous gelatinous shreds of the Echinococci, as was done, 

 for example, by Robin in Vigla's case. Dr. Pockels, of Holz- 

 minden, has also informed me of two cases in which Echino- 

 coccws-vesicles were expectorated. One patient recovered, the 

 other died. 



These are the only cases in which we can with certainty esta- 

 blish the diagnosis of Echinococci during life. All other cases 

 in which unopened swellings are characterised positively as 

 Echinococci during life, are to be classed more or less in the 

 series of diagnostic tricks, which may succeed with the most prac- 

 tised hand nine times, and fail him on the tenth. The diagnosis 

 can never be brought beyond one of probability, and the surgeon 

 must be contented to make his diagnosis for a sacculated swelling 

 filled with fluid or cystic swelling, and merely endeavour to dis- 

 tinguish the swelling from solid, parenchymatous tumours, as to 



