RATE OF GROWTH AND PROGNOSIS. 643 



hindrance to birth, and had to be opened, he found hydatids to be 

 the cause of the swelling, 1 but this has probably nothing to do with 

 the Echinococcus. The same may be said of Cruveilhier's case of a 

 child twelve days old, in whose liver there are said to have been some 

 calcified hydatid cysts. 2 The bladders found byHeyfelder 3 in the 

 placenta and umbilical cord of a foetus of seven months, are to be 

 referred to a so-called " hydatid mole," which, as is well known, has 

 nothing in common with the Echinococcus. 



The slow growth is quite sufficiently shown by my reports of the 

 dissections of animals which had been used for rearing the Echino- 

 coccus. But under some circumstances this growth can be directly 

 observed in man. Velpeau, for example, reports a case of Echinococcus 

 in the neighbourhood of the shoulders, which in six months grew to 

 the size of a small walnut. In another case an Echinococcus similarly 

 situated grew within a year to the size of a fist. 



The growth of the Echinococcus is, however, by no means the same 

 in all cases. It is affected by the position and character of the 

 attacked organ, by the form of the worm, and by individual circum- 

 stances of the most manifold nature. The hydatid Echinococcus seems 

 to have the longest and most continuous growth, and in time often 

 attains quite an enormous size. It is true that this requires years, and 

 even decades. We have already mentioned such a case, and several 

 similar ones are recorded in literature. 4 



Thompson treated an Echinococcus of very large size, the first 

 traces of which had been observed thirty years before ; and Raynal 

 operated on a woman, in whom the swelling had gradually spread 

 during forty-three years over a considerable portion of the face, and 

 attained the size of a child's head. On incision numerous daughter- 

 bladders shot forth, which had a perfectly healthy appearance, and 

 some of which were only the size of peas. 



As a rule, however, the Echinococcus comes sooner to an end, and 

 usually by causing the death of its host. Perhaps the great danger 

 of the Echinococcus is best shown by a paper of Barrier's, 6 in which 

 he mentions that of twenty-four cases with which he was somewhat 

 exactly acquainted, more than half terminated fatally during the 

 course of the first five years. Three Echinococci had an existence of 

 less than two years, eight of two to four, and four of four to six. Of 

 the rest, three caused death after six to eight years, two after eight 

 years, and four after fifteen, eighteen more than twenty and more 



1 Neue Zcitschrift f. GeburtsTcunde, Bd. iv. 



2 "Traits' d'anat. pathol.," xxxvii., p. 6. 

 8 Schmidt's Jahrb., p. 324, 1834. 



4 See Davaine, loc. cit., p. 384. 



6 "De la tumeur hydatique du foie," p. 36, These Paris, 1840 (quoted by Davaine). 



