702 DISEASES OF THE LIVER. 



child's head or become even larger. The connective-tissue stroma is 

 generally far advanced in fatty metamorphosis. The cells opened by 

 an incision strongly remind us of the holes on the cut surface of a 

 piece of well-baked black bread. On microscopic examination of the 

 gelatinous substance contained in them, we immediately recognize the 

 characteristic membrane of the echinococcus, which is strewn with 

 numerous chalk concrements. On the other hand, it usually requires 

 a long search to discover a circlet of hooks or single members from it, 

 and we rarely find perfect scoleces. In a single one of my cases, at 

 the periphery of the tumor there were vesicles as large as a cherry, 

 whose inner wall was thickly covered with a colony of well-preserved 

 scoleces. In all reported cases, except my last one, the centre of the 

 mass had suppurated ; the cavity resulting from the suppuration con- 

 tained a dirty brownish-gray fluid, which consisted mostly of detritus 

 masses, chalky concrements, fat globules, and cholesterin crystals. 

 The wall, rendered uneven by numerous small fossa3 (opened alveoli), 

 had in many places an ochre-colored coating in which beautiful hsema- 

 toidin crystals could be seen microscopically. 



SYMPTOMS AND COURSE. Of course the symptoms of multilocular 

 hydatids must vary with the canal system of the liver, which is filled 

 and obstructed with the echinococcous masses. This explains the 

 remarkable fact that the somewhat hasty description of the symptoma- 

 tology given by Friedreich of the multilocular hydatid cyst so ex- 

 actly suits some cases, that the disease has been repeatedly diagnos- 

 ticated from that description; while in other cases even the most 

 prominent points of his description have been wanting. I shall try 

 to avoid Friedreicfts errors in the following description, which is 

 taken partly from my own comparatively numerous observations, partly 

 from a careful analysis of the reported cases of other observers, which 

 are not very numerous : 



The disease is almost always latent at the commencement ; as a 

 rule, the first symptoms appear after it has made considerable progress. 

 Some patients have their attention called to the disease by a feeling 

 of pressure and fulness in the right hypochondrium, or by the acci- 

 dental discovery that they have a tumor in the abdomen. They have 

 nothing else to complain of; the appetite and digestion are good ; the 

 strength and nutritive condition leave nothing to desire ; there is no 

 jaundice or symptoms of obstruction in the roots of the portal vein. 

 On examining the abdomen, we find in the right hypochondrium a 

 tumor, which unmistakably belongs to the liver ; the liver may either 

 retain its normal shape, or there may be slight elevations on its surface, 

 such as occur in carcinomatous and syphilitic diseases. Even where 

 there is extensive central suppuration, the resistance of the liver tumoi 



