ECHINOCOCCUS DISEASE 533 



tid thrill appears to be the waves of the fluid contents of the cyst; it is, there- 

 fore, to a certain extent only a distinct fluctuation. This condition also occurs 

 in cysts of the ovaries, in ascites, etc. Santini and Rovighi have observed 

 that the echinococcus cysts, besides the hydatid thrill, convey also, upon simul- 

 taneous percussion and auscultation, a characteristic, deep, sonorous tone, the 

 so-called hydatid resonance. This phenomenon is said not to be present in 

 deep seated cysts with thickening and degenerating walls. The size and extent 

 of the cyst, as was demonstrated by Manasse in a case of renal echinococcus, 

 may be determined by the Eontgen rays. Confusion of the echinococcus cyst 

 with other tumors or abscesses, such as cystic degeneration of the kidneys, 

 ovarian cysts, tumors of the uterus, tumors of the omentum, of the pancreas, 

 subphrenic abscesses, etc., can, of course, never be entirely avoided. In spite 

 of the most minute examination of the history, of the results of inspection, 

 of palpation, and of percussion, and of the relation of the tumor to neighbor- 

 ing organs, the diagnosis in some cases cannot he made with absolute certainty 

 unless some definite points of support are obtained by rupture of the cyst 

 and an admixture of its contents with the sputum, with the vomitus, with 

 the contents of the intestines, and with the urine. In cases which offer great 

 diagnostic difficulty, an exploratory puncture may at once clear the entire 

 clinical picture by the recognition of a fluid which is non-albuminous, and 

 which contains scolices or booklets. But the danger of this process will cer- 

 tainly always limit its use in diagnosis. 



The prognosis depends upon the location, the size, and the relation of the 

 echinococcus cyst to its surroundings. Although a benign tumor in itself, 

 it may, particularly by suppuration, lead to phenomena which endanger life. 

 In multiple echinococci the prognosis is correspondingly more unfavorable. 



TREATMENT 



Prophylactic measures miist be premised with a caution, which cannot be 

 too emphatically expressed, against intimate association with dogs. In infected 

 regions their number should be limited as much as possible. Whether methodic 

 tape-worm cures, on account of the perhaps brief parasitism of the tenia in 

 the dog, are of any use, is doubtful. On the contrary, the important point 

 in prophylaxis, it appears to me, is to protect the dogs from acquiring the 

 tenia echinococcus. This may be best attained by the introduction of the 

 compulsory inspection of meat. All organs infected with echinococci must be 

 destroyed by cremation. Meat inspection in the country districts among cattle 

 raisers is not likely to find favor when they learn that annually in Prussia 

 about 880 cattle directly succumb to the echinococcus pest. The indirect harm 

 arising from this is that animals infested with echinococcus^ suffer in their 

 nutrition, and are prematurely slaughtered, and this may be an important pomt 

 in agriculture. 



Internal treatment is ineffectual, and successive punctures with aspiration 

 of the contents as well as injections of medicated fluids should be rejected 

 for the above-mentioned reasons. . 



On principle I am opposed to the method introduced by Baccelli of mjec- 



