ECHINOCOCCUS DISEASE 541 



by decided pain and rapid loss of strength. Differentiation between hepatic 

 abscess and a suppurating echinococeus cyst is frequently very difScult. 

 Neither is differentiation between a cyst and a soft cancer nodule easy, for 

 such nodules may frequently produce the signs of fluctuation. Confusion 

 with dropsy of the gall-bladder may readily be avoided, as its position remote 

 from the liver, the form of the tumor, and the anemia will poiat out the 

 correct diagnosis. 



The oval form of hydronephrosis, the immobility in respiration, its posi- 

 tion in relation to the colon, palpation in the knee-elbow position, and an 

 examination of the urine will prevent us from confounding echinococeus with 

 hydronephrosis. 



Multilocular echinococeus also frequently exists for a long time without 

 symptoms, and then the sensation of fulness and heaviness in the epigastrium 

 and stubborn jaundice appear. Bulging in the hepatic region constantly in- 

 creases as the result of the decided enlargement of the organ. Palpation 

 reveals a tumor of hard consistence like cartilage; the surface is smooth and 

 nodulated. Fluctuation at first is limited to individual parts. The spleen 

 is usually enlarged. Nutrition gradually suffers; ascites, anasarca and at- 

 tacks of fever occur. Death results after one or several years, accompanied 

 by the symptoms of marasmus. 



In form and size, and in the hardness of the liver, multilocular echinococeus 

 resembles hepatic cancer. But the course of the disease is slower, and nutritive 

 disturbances develop only in the advanced stages. Syphilis of the liver pre- 

 sents other forms and degrees of enlargement. The chills and marked jaun- 

 dice which usually occur in abscess of the liver will differentiate this affection 

 from multilocular echinococeus. Hepatic cirrhosis and amyloid liver will, as 

 a rule, be easily differentiated from the hydatid. The prognosis has usually 

 been considered absolutely unfavorable. We have already called attention to 

 the results recently obtained by operation. 



Echinococeus of the pancreas has been described by Subboitic, Pericic and 

 Salis. 



Echinococeus of the spleen is rare ; according to the Pomeranian statistics 

 it occurred in 4 per cent, of the cases, in the Mecklenburg statistics in only 

 1.96 per cent. The parasite finds a favorable medium for its growth in the 

 soft splenic tissue. In the main, the symptoms of splenic echinococeus resem- , 

 ble those of hepatic echinococeus, but with the difference that the formation 

 of tumor is only upon the left side. Splenic echinococeus is not rarely com- 

 plicated by echinococeus of other organs. 



Echinococeus of the kidney, which in the Mecklenburg statistics consti- 

 tutes 3.5 per cent, of the cases, and in the Pomeranian 4.58 per cent., usually 

 develops in the cortical substance. Renal echinococci for the most part are 

 unilateral. As it grows all parts of the kidney may be implicated in the 

 disease, and the kidney be transformed into a large echinococeus cyst. This 

 cyst extends into the abdominal cavity, and leads to dislocations and to adhe- 

 sions to neighboring organs. Diseases of the most varied kind may thus 

 be simulated. Small tumors produce no symptoms ; larger ones cause pressure 

 phenomena, difficulty in respiration, etc. After years the symptoms of maras- 



