THE LIVER. 609 



with a transparent or turbid fluid. Not infrequently the cysts are 

 sterile, and are then simply filled with clear or turbid fluid ; or the em- 

 bryos may have died and disintegrated, and their detritus, including the 

 hooklets, may be intermingled with the fluid contents of the cysts. The 

 contents of the cysts may be mixed with fat, cholesterin crystals, pus, 

 bile, or blood ; or form a grumous mass, in which we may or may not 

 be able to find the hooklets of the scolices or fragments of the lamellated 

 wall. The connective tissue of the walls of the cysts may be greatly 

 thickened, or they may be calcified. 



In other countries the lesion is much more common and frequently 

 more formidable than in the United States. The cysts reach an enor- 

 mous size, the veins of the liver may be compressed and filled with thrombi, 

 the bile ducts compressed and ulcerated. So much of the liver tissue 

 may be replaced by the hydatids that the patient may die from this cause 

 alone. Very frequently there is local peritonitis, and adhesions are 



FIG. 372. Ecmxococcrs MCLTILOCULARIS OF THE LITER. 



A section of a small portion of the cystic and fibrous growth in the liver. There were no booklet* 

 within the cysts in this case, but the delicately lamellated character of the lining membrane sufficed for a 



formed between the liver and the surrounding parts. In some cases the 

 cysts rupture, and their contents are emptied into the peritoneal cavity, 

 the stomach, the intestines, the pleural cavity, or the lung tissue. Some- 

 times the cysts perforate the bile ducts, the vena cava, or some of the 

 branches of the portal or hepatic veins ; or the abdominal wall is perfo- 

 rated and a fistula formed between the cavity in the liver and the surface. 



Echinococcus multilocularis (see page 137), which is apparently an 

 abortive form of the above species, is very rare in the United States 

 (Fig. 372). 1 



Distoma hepaticum, D. sinense, D. lanceolatum, may occur in the gall 

 ducts and gall bladder. D. sinense occurs especially in the East, and has 

 been found in great numbers in the bodies of Chinamen. D. haematobium 



^ee Oertel, Yale Medical Journal, vol. v., p. 233, 1899; consult also monograph 

 by Posselt, 1900. 

 39 



