T^NJA ECHINOCOCOUS. 285 



methods of detecting the presence of hydatids. Only a compara- 

 tively few cases are known where the diagnosis has been effected 

 with absolute certainty. No doubt the presence of a fluctuating 

 tumour, without concomitant inflammatory symptoms, especially if 

 it be seated in the region of the liver, together with the circum- 

 stance of its slow growth unattended with any particular degree of 

 functional disturbance, would, to most minds, suggest the possible 

 and probable presence of one or more hydatid cysts. Then there 

 is the so-called "hydatid fremitus" of Piorri, which can scarcely 

 differ from the ordinary impulse communicated by fluid matter 

 within any other kind of tumour. Generally speaking, the acci- 

 dental discharge, or the escape of one or more acephalocysts after 

 incision, constitutes the only absolutely certain diagnostic symptom. 

 As regards their treatment — supposing a satisfactory diagnosis 

 to have been accomplished — this, of course, in ninety-nine cases out 

 of every hundred, has reference to the speedy evacuation of the 

 contents of the tumour. A great deal of nonsense has been written 

 about particular drugs, whilst the use of electricity has been 

 warmly advocated by a few. Those who desire further ideas on 

 this score may possibly derive advantage from consulting Davaine's 

 treatise ; but in the words of Dr. Todd (who wrote on this subject 

 in 1851), I may say that " I know of no cure for hydatids but the 

 evacuation of them. There is a popular notion that salt will kill 

 the hydatid. Iodide of potassium has also been frequently tried, 

 but I have never seen any real benefit from the use of these 

 remedies." To this it may be added that the employment of a 

 trochar for evacuation of the hydatid contents, and the subsequent 

 injection of iodine, is a plan which has several times proved suc- 

 cessful. In those cases, however, where a serous cavity intervenes 

 between the cyst and the surface of the skin, the most serious 

 mischief may accrue from the escape of some of the hydatid fluid 

 into the cavity. M. Boinet and others have pointed out the proper 

 precautions to be observed in such cases ; but for these and all 

 similar particulars, whatever their value may be, I need only refer 



