TREATMENT. 167 



assume ; a correct knowledge of these can only be 

 acquired by a frequent and extended experience at the 

 post-mortem table. More frequently a rounded bulging 

 of the liver is felt in the right or left hypochondriac and 

 epigastric region. Oil palpation hydatids are felt as 

 smooth, globular, elastic tumours ; on percussion they 

 yield a peculiar vibration or trembling, which is felt 

 distinctly when the tumour is gently compressed by two 

 fingers of the left hand and struck abruptly with the 

 right hand. There is but little pain attending echino- 

 cocci of the liver ; the disease develops itself slowly 

 and insidiously, without any fever, stomach, or bowel 

 derangement, jaundice or ascites. But when the growth 

 of the tumour increases to such an extent as to act as a 

 mechanical pressure upon the adjoining viscera, then 

 we encounter a series of distressing symptoms ; there is 

 difficulty of breathing, there is a short dry cough, and 

 palpitation of the heart, there is frequent vomiting and 

 obstructed defsecation, and there are varicose veins and 

 general cedema of the lower extremities ; symptoms 

 which indicate consecutively the rising of the animals 

 into the thorax, the dislocation of the heart, compres- 

 sion of the stomach and bowels, and pressure on the 

 vena cava. 



TREATMENT. 



I propose to divide the treatment of " Hydatids " and 

 11 Echinococci " under the three following heads, viz., 



1. The Prophylactic, 



2. The Therapeutic, 



3. The Surgical. 



1. PROPHYLACTIC. Frerichs, in his elaborate work on 



