650 OCCURRENCE AND MEDICAL IMPORTANCE. 



been observed only a few times, and always associated with complete 

 loss of sight. The Echinococci in the brain are still more serious, and 

 have always, after a longer or shorter period, a fatal issue. 1 As a rule 

 the disease is first manifested by violent and continual pain in the 

 head and joints, not unfrequently as a decided neuralgia, accompanied 

 by giddiness, fainting, and vomiting. Sooner or later attacks of cramp 

 begin to occur with varying frequency, and sometimes of a decidedly 

 epileptic character. The sensory and cerebral functions are gradually 

 increasingly disturbed, voluntary movement is suspended, and death 

 supervenes sometimes after apoplectic ruptures and softening round 

 about the parasite. 



Those in the muscles and peripheral organs (thorax, salivary glands, 

 oral cavity, &c.) are on the contrary almost harmless. They only act 

 as hindrances, impeding the functions, and are usually readily removed. 



Since these superficial Echinococci are on the whole but rare, our 

 judgment as to the clinical importance of the worm can hardly be 

 thereby modified. We are forced to regard it as one of the most 

 dangerous parasites infesting man, dangerous because of the disease it 

 originates, dangerous also because we are in many cases, and these the 

 most serious, quite helpless against it. Since we can do so little to 

 dislodge this unwelcome guest, it is a weighty fact that Nature herself 

 sometimes sets a limit to the destructive work. As we have noted, it 

 by no means rarely happens that the Echinococcus dies either at an 

 earlier or later stage of development. The cause of this phenomenon 

 has usually been sought in certain conditions of the surrounding cyst. A 

 change is to be observed affecting the granular cellular layer over-lying 

 the bladder. This is at first not unlike a serous coating, but it begins 

 to become loose and turbid. It frequently changes into a creamy or 

 caseous mass, 2 accumulating ever more and more round the bladder- 

 worm. 3 The latter seems for a while hardly in any wise altered. But 

 on closer examination one is convinced that the parenchyma is softened 

 and has undergone fatty degeneration, that at some points it has been 

 separated from the cuticle, and that the heads swim about freely in 

 the fluid, and present a more or less altered appearance. At a later 

 stage this fluid is exuded. It collects round about the bladder-worm, 

 and forms a thick mass of a glue or honey-like character, being 

 more or less mixed with the granular substance of the cyst- wall. The 

 bladder collapses in consequence of the loss of the fluid. It shrivels 



1 Westphal's case of an intracranial EcMnococcus, from which the patient recovered 

 (Berliner klin. Wochemchr. , No. 18, 1873), is quite unique. 



2 See the above cited observations of Kuhn, " Rech. sur les acdphalocystes, " and 

 Cruveilhier, " Anat. path. ge"n., M t. iii., p. 550. 



3 I have seen livers of cattle in which all the Echinococci were thus changed, so that 

 one was compelled to look for the cause in the state of the affected organ. 



