ECHINOCOCCUS DISEASE 548 



palpation or by adhesions. If the intestine is in front the tympanitic note 

 of the latter is the most important diagnostic symptom. 



Echinococcus of the omentum is rarely unilocular. Cases of this kind have 

 been published by Griinig and Liitkemiiller. 



Echinococcus of the true pelvis and of the genitalia. In the male, echino- 

 coeci in the true pelvis develop in the space between the rectum and the blad- 

 der. Their growth leads to disturbances of function of the rectum and bladder. 

 Now and then perforation into the rectum occurs. 



In the female we find echinococcus in the uterus, in the ovaries, in the 

 ligamenta lata, in the anterior and posterior halves of the pelvis. 



In the uterus the echinococcus usually develops in the submucous tissue. 

 Scanzer's view that the embryo in its wanderings reaches the abdominal open- 

 ing of the Fallopian tube grasped by the fimbriae, enters the cavity of the 

 uterus, and develops fully there, is quite properly rejected by Schatz for the 

 majority of cases. The submucous seat is explained by Schatz from the cir- 

 cumstance that the embryo, owing to greater strength of the blood current 

 in that direction, particularly at the time of menstruation, is forced against 

 the interior muscular layer near the mucosa. It evidently develops in the 

 muscles, and finally, when labor pains occur, enters the cavity of the uterus 

 through the muscles which have gradually become atrophic. The hydatid has 

 also been found in a subserous position. 



The echinococcus lodged in the wall of the uterus is commonly mistaken 

 for a myoma, if echinococci have not appeared in other organs. The circum- 

 stance that the wall of the uterus, which in the case of myoma is usually 

 decidedly hypertrophied, is not found so in the case of echinococcus 

 (Schatz) may be utilized in the diagnosis. Subserous myomata develop 

 only a moderate muscular hypertrophy; their consistence is not character- 

 istic. Thirteen cases are mentioned in literature in which the echinococcus 

 sac was an impediment at birth ( Schmidt, " Ueber Ech. in weibl. Becken," 

 Diss. 1893). 



Echinococci of the ovaries and ligamenta lata are rare. Schultze could 

 collect from literature only eleven cases of echinococcus of the ovary, to which 

 he added two cases that came under his own observation. Schatz remarks 

 concerning the diagnosis that a tumor of about the size of an orange, very 

 deeply seated near the uterus, should cause us to suspect echinococcus. Later 

 a group of such tumors, of equal size and closely situated, forms an important 

 diagnostic symptom. Extrauterine pregnancy on account of its rapid progress, 

 and disease of the tubes on account of the characteristic form of the enlarge- 

 ment, can scarcely be confounded with echinococcus. Beowit recently saw 

 both tubes transformed into echinococcus sacs. 



Echinococcus of the cellular tissue of the pelvis is in the majority of cases 

 found upon the inner surface of the posterior wall, less frequently upon the 

 anterior. The diagnosis is greatly facilitated by the ease with which the 

 diseased area may be reached. Echinococcus of the pelvis may be suspected 

 if one or several smooth, tense, elastic but slightly movable tumors, not painful 

 upon pressure, are found, and the ovaries may be distinctly determined. In 

 many cases the cyst is situated between the uterus and the rectum. Fever 



