ECHINOCOCCUS DISEASE 535 



bra itself, penetrating externally or internally. In some cases the parasite grows 

 outwardly into the vertebral canal. Maguire mentions two cases in which the 

 parasite developed in the spinal cord itself. 



The symptoms are those of compression. The first phenomena frequently 

 arise from disease of the vertebra, and from compression of the nerve trunks. 

 The symptoms develop gradually, and resemble those of a compression myelitis. 

 The entire absence of pain and the free movability of the vertebral column are 

 conspicuous; this, however, may also be the case in tumors. Diagnosis be- 

 comes possible when the parasite appears. The prognosis has usually been 

 unfavorable. In the case reported by Szkekeres, operation was attempted after 

 a piece of bone one-half a centimeter in length had been exfoliated. 



Echinococcus of the orhit. Echinococcus of the eye-ball has as yet not 

 been determined with certainty, and echinococcus of the orbit is also rare. 

 Kramer has collected 68 and Golowin 93 observations. To these may be added 

 the cases of Ziegler, Wagenmann and Blaschek. It is noteworthy that, accord- 

 ing to Kramer, the disease occurs three times as frequently in men as in women. 

 In two-thirds of the cases the patients were between the eleventh and twenty- 

 first years of life. As a rule, the echinococcus develops primarily in the orbit, 

 in rarer cases it finds it way into neighboring organs after destruction of the 

 wall of the orbit. The parasite is found in both orbits with about the same 

 frequency, and almost always in the base; rarely in the anterior lateral parts. 

 The development is usually insidious, seldom fulminant. The first symptoms 

 are commonly pain and the development of an exophthalmos. The conjunc- 

 tiva and lids become inflamed. Decrease in motion of the bulbus oeuli, dis- 

 turbances of vision, and loss of sight in varying grades appear gradually. 

 Suppuration is not rare. In cases in which no operation is performed, early 

 atrophy of the optic nerve, necrosis of the cornea, and panophthalmia occur. 

 The diagnosis is often very difficult. Confusion with malignant neoplasms 

 has several times led to enucleation. Kramer cautions us against exploratory 

 puncture on account of the danger of confounding the condition with that pro- 

 duced by an encephalocele. The slow development of a tumor in the orbit 

 without fever, severe pain deep in the orbital cavity, a tumor with distinct 

 or indistinct fluctuation, and the early appearance of disturbances of sight are 

 all strongly indicative of echinococcus. The treatment is surgical. 



The echinococcus has been twice observed in the frontal sinus, which had 

 ruptured into the orbit. 



In the nose, in the oral cavity, in the tongue, in the gums, in the pharynx 

 and in the parotid the echinococcus has also occasionally been observed. 



Echinococcus in the neck is a rare occurrence. Giiterbock has collected 

 26 cases of this kind. Besides these I found cases recently published by Reich, 

 Jiirgens, Thevenot and Steinbriick. The parasite generally chooses as its seat 

 the region of the external border of the sternocleidomastoid; this without 

 doubt accounts for its originating in the sheaths of the large vessels of the 

 neck. The echinococcus sac slowly raises the sternocleidomastoid and appears 

 at the internal border of the muscle as a small tumor, while the larger portion 

 of the sac is situated upon the external border. The connection of both tumors 

 is proven by the continuance of the fluctuation. Later, with increased growth, 



