ECHINOCOCCUS DISEASE 531 



rania that certain customs and habits of the people, their sex, social condition 

 and occupation, their residence in the city or in the country, create a special 

 predisposition to acquire the parasites. Echinococcus disease represents a 

 slow, often insidious process, running its course for several decades, and the 

 occasional cause, the place and time of infection, cannot be determined. 



In the majority of cases only one organ is attacked. Unilocular echino- 

 coccus disease most frequently has its seat in the liver. If several organs are 

 attacked — echinococcus multiplex — the liver is found to be one of the organs 

 affected. 



Several series of statistics have been compiled with regard to the frequency 

 of " dog tape-worm." These indicate clearly that the liver is the organ most 

 frequently affected ; in the Mecklenburg investigation there were 69 per cent, 

 of such cases, in that of Pomerania, 67.33 per cent. As the next organ to 

 be implicated, the lung may be mentioned, showing 11.9 per cent, and 10.6 per 

 cent, following this the kidneys with 3.5 per cent, and 4.6 per cent. 



The abdominal cavity, skin, and musculature .are also quite frequently 

 attacked, that is, in about 6 per cent, of cases; but, in fact, any organ may 

 be the seat of an echinococcus cyst. The view that traumatism favors the 

 accumulation of the infectious agents may probably be due to the fact that 

 after injuries the echinococci, which until then have been latent, manifest clin- 

 ical symptoms. The conditions are certainly different with the appearance of 

 multiple echinococci, especially in the abdominal cavity. The opinion that the 

 simultaneous invasion of many organisms may here be the cause will often 

 prove correct. But another mode of development may also be observed; 

 namely, autosemination after puncture or rupture of an echinococcus sac. 

 Since v. Volkmann first called attention to this danger, I have observed it 

 clinically in many cases. The colonizing and propagation of cysts in the 

 abdominal cavity has been absolutely proven by the experiments of Eiemann 

 under the direction of Garre. Similar experiments undertaken by other inves- 

 tigators and by myself failed of success, for some unknown reason. Either on 

 account of the danger of disseminating the echinococcus parasite, or because 

 of the toxicity of the echinococcus fluid, exploratory puncture has fallen into 

 disuse. 



The danger that the subsequent oozing of the echinococcus fluid from the 

 point of puncture may bring about serious accidents and even death has been 

 demonstrated by numerous observations. The appearance of urticaria after 

 aspiration is a not infrequent occurrence. In a patient in Hosier's clinic, a 

 few hours after the aspiration of an echinococcus of the liver, an eruption 

 of urticaria appeared, soon followed by cyanosis and dyspnea. Only after the 

 lapse of several hours did the threatening symptoms disappear. Other authors 

 report the appearance of fever, singultus, nausea, arthritic pains, etc. A 

 patient of Jenkins's died with these symptoms ; Martineau and Bryant report 

 similar cases. Experimental investigations also confirm the view that the 

 echinococcic fluid may have a toxic action. Brieger, for instance, isolated 

 among other substances one which he obtained in the form of salt of platinum, 

 and, after separating it from the metal, he injected it in solution into mice 

 with rapidly fatal result. Aspiration is not advisable, unless the radical oper- 



