534 THE ANIMAL PARASITES OF MAN 



tions of corrosive sublimate, although a number of eases have been reported 

 with favorable results. The process consists in aspiration of the cyst contents 

 with a succeeding injection of a 1-1,000 corrosive sublimate solution. I have 

 seen recovery occur after puncture, even without injection of drugs, but much 

 more frequently suppuration followed and tinally made laparotomy necessary. 

 Recovery through surgical means can only take place by the removal of the 

 echinococcus sac. 



The seat of the diseases is usually the liver. For this reason I should like 

 briefly to describe the treatment of echinococcus of the liver. Madelung de- 

 fines extirpation of the cyst including the capsule as the unquestioned " ideal " 

 method of treatment. If of moderate size, with a superficial seat, and there 

 is no suppuration, this operation will bring about the best results. In the 

 majority of cases, the choice between a radical operation or one performed at 

 two different times comes into question. If danger is present, the single or' 

 less radical operation is to be preferred on account of its greater rapidity. 

 This is also recommended if the cyst is insufficiently exposed in the field of 

 operation, or if, with multiple cysts, after the removal of one cyst the others 

 are more easily reached. The method also by which an incision is made has 

 the advantage of being less dangerous. As a rule, this method is resorted to 

 if there are no special indications for more rapid interference. 



Multilocular echinococcus has in only a few cases been treated by opera- 

 tion ; namely, by Brunner, Terillon and Bruns. The latter advises cuneiform 

 excision. Only the smaller multilocular echinococci can be successfully re- 

 moved by operation. 



ECHINOCOCCI OF VARIOUS ORGANS 



I shall briefly review the echinococci found in different organs : 

 Echinococci of the Irain are rare. Davaine mentions 33, Neisser 68 cases. 

 Upon the whole about 90 cases are known, and among these is one case of 

 multilocular echinococcus. Usually the parasite is solitary. It is generally 

 of moderate size. The cysts are situated in the white as well as in the gray 

 substance, and are surrounded by connective tissue capsules ; the neighboring 

 cerebral substance is anemic, partly atrophic. After a fairly prolonged time 

 of growth a hemisphere may resemble a sac with thick walls. Several times 

 after penetrating the skull, growth and discharge externally through the nose, 

 ear, etc., have taken place. Westphal observed a case in which about 90 cysts 

 were discharged. The seat and the size of the tumor determine the symp- 

 toms. General cerebral and focal phenomena appear until we have the symp- 

 toms of cerebral tumor. The diagnosis of the nature of the tumor will be 

 possible only when echinococcus disease of another organ is present, or if, in 

 the course of the disease, external perforation occurs. If the nature of the 

 tumor and the localization of its seat are determined, surgical treatment may 

 be successful. In the main the prognosis is unfavorable. 



Echinococcus of the spinal cord is even rarer than that of the brain. About 

 22 cases in all are known. Usually the parasite is found between the dura 

 and the vertebra, more rarely in the dural sac; or it may develop in the verte- 



