MULTIPLE ECHINOCOCCI. 633 



estimates the number of Echinococci in the liver at 69 per cent., and 

 those of the abdominal thoracic viscera (lungs only 3 per cent.) 

 altogether at 95 per cent., so that the extra visceral occurrence appears 

 to be rather the exception. 



As a rule, the number of Echinococci which attain development in 

 man is limited to one or to very few, which are then found either in 

 neighbouring organs, or more commonly in the same. Where only 

 one organ suffers, it is almost always the liver. But curiously enough 

 in man this organ is but rarely tenanted by a large number of 

 Echinococci, such as one sometimes finds in the animals used for food, 

 and especially in swine, whose liver is sometimes penetrated by 

 hundreds of distinct Echinococcus-bl&ddQrs. 1 There are, indeed, in- 

 stances in man where the number of Echinococci considerably increases 

 and the sphere of distribution becomes more extensive. In all cases 

 of multiple Echinococci the liver is probably one of the affected organs, 

 but the majority of the parasites are nevertheless usually found in 

 other parts, especially in the onientum and peritoneum, but also in 

 the lungs, spleen, and kidneys. Thus Wunderlich 2 describes a case 

 in which, besides a hydatid Echinococcus in the liver as large as a 

 child's head, there were in the spleen, in the retro-peritoneal space, in 

 the omentum, behind the csecum, in Douglas' pouch, twelve other 

 bladders, varying from the size of an apple to that of a fist, while 

 under the mesenteric coating of the small intestine there were about 

 half a hundred " dried " Echinococci, whose size varied from that of a 

 poppy-seed up to that of a bean. 



In another case reported by Davaine, 3 the liver contained a large 

 number of small Echinococci, which projected only slightly from the 

 surface, but beside these were two larger sacs, of which one contained 

 at least three pounds of fluid, with many daughter-bladders, some of 

 them of the size of an egg. There were also numerous larger 

 Echinococcus-lalsidders in the true pelvis, between the bladder and the 

 rectum, in the gastro-hepatic and gastro-splenic ligaments, in the wall 

 of the transverse colon, and in the neighbourhood of the caecum, 

 besides numerous small bladders, some only the size of peas, under 

 the peritoneal coating of the intestine. 



In the absence of exact reports it is difficult to determine with 

 certainty the number of the bladders in such cases. Wunderlich 



1 Through the kindness of Professor Nitsche in Tharand, I lately received half of a 

 pig's liver, which was penetrated by hundreds of (sterile) Echinococci, about the size of 

 nuts, whose cysts lay so close to each other that the liver substance was largely compressed, 

 and in spite of its weight of thirty-six pounds, was really little more than a trabecular 

 structure of connective tissue, in which the bladder-worms were embedded. 



2 Archivf. physiol. Heilk., p. 283, 1858. 

 8 Mtm. soc. biol, p. 106, 1857. 



