HYDATID TUMORS 
IN THE BRAIN. 
15V R. HARVEY REED, M. D., 
OF MANSFIELD, OHIO. 
Read in the Section of Practical Medicine, Materia Medica and 
Physiology, at the Thirty-Sixth Annual Meeting of the 
American Medical Association. 
Reprinted from the Journal of the American Medical 
. Association, July 4, 1885. 
Printed at the Office of the Association. 
1885. 
CHICAGO: HYDATID TUMORS IN THE BRAIN. 
By the term hydatid tumors in the brain, we mean 
the intra-cranial occurrence of either the echinococ- 
cus or the cysticercus cellulos e in man. The former 
is the embryo of the taenia echinococcus which has 
never been known to attain maturity except in the 
dog. The latter is the embryo of the taenia solium, 
which is most frequently found in man, the hog, and 
the rabbit, but not unfrequently in the dog and the 
common rat; and has been known to exist in the 
ape, the bear, and the deer. 
The history of these strange parasites is only traca- 
ble to the oblivion of the unknown; before the time 
of Aristotle they were known to be associated with 
hydatid tumors, and were so regarded by Hippo- 
crates; although it was left for Pallas to describe the 
echinococcus as a separate parasite, in 1766, and for 
Goze to observe the same of the cysticercus in 1784. 
The Mosaic law, which denounced as unclean all 
those animals which split the hoof and did not chew 
the cud, or those which chew the cud and did not 
split the hoof, was undoubtedly based on the exist- 
ence of these parasites, for it is a well-known fact 
that the hog, and a species of hare common in the 
east, were particularly rife with the disease produced 
by these parasites. Nor were all the animals con- 
sidered clean by the Mosaic law even free from this 
loathsome disease; for we find, on referring to the 
older works on sheep husbandry, the same disease 
treated of, under the synonyms of “turnstick,” “stur- 
dy,” and “staggers,” and more recently as “hydatid 
polycephalis cerebrais;” which proved to be very 
fatal in the flocks where it prevailed, and was des- 
cribed as a many-headed hydatid, each of which was 
mounted with a disk of sharp hooklets. The devel- 
opment of these parasites from the tape-worm through 2 
all their multiple metamorphoses until again a tape- 
worm, was for a long time enshrouded in mystery; 
and it was not until comparatively recently that all 
the links in the chain were finally united. 
In order that our subject proper may be better 
understood, we will give but a brief outline of the de- 
velopment of these taeniae, which, during a certain 
stage of their development, may form cysts in the 
brain, or its membranes, of man. From Kiichen- 
meister, the eminent German authority, we have crys- 
talized the following: 
Division A.—Taenia echinococcus, i. Is found 
only in the dog, has but four joints, the last of which 
contains the genital organs, and also the ripe eggs. 
2. When these eggs find their way into the stomach 
of man they migrate, as soon as germination takes 
place, through the system and there develop the 
echinococcus which first form the so-called mother, 
or brood cysts. 3. These mother or brood cysts may 
develop as follows: (a.) The scolices or heads, di- 
rectly from the mother cysts, when they are called 
echinococcus scolicipariens, and is frequently known 
under the name of E. veterinorum, owing to its fre- 
quent occurrence in the domestic animals, and is 
distinguished from the fact of its having from 28 to 
36 hooklets. (/>.) The mother cysts may develop 
daughter cysts or even granddaughter cysts, and from 
either of these latter cysts may develop the scoli- 
ces, in which case they are called the E. altricipariens, 
and from their frequent occurrence in man they are 
also known as the E. hominis, and can be distinguish- 
ed by the fact of their having from 46 to 52 hooklets. 
(V.) The mother cysts may develop scolices exter- 
nally, as is generally the case in animals, and from 
this fact they have received the name of exogens. 
(</.) Or the mother cysts may develop scolices inter- 
nally, as is most frequently the case in man, when 
they are termed endogens. (e.) Lastly, the mother 3 
cysts may not develop scolices at all, when they are 
known as acephalocysts. 
When these cysts or their scolices find their way 
into the stomach of the dog they develop into the 
taenia echinococcus; but should they find their way 
into the stomach of any other animal they will not 
reach maturity; although the embryo in the form of 
hydatid cysts will develop in man, as well as others 
of the animal kingdom, and will live in this embry- 
onic state for years, or until it destroys the life of its 
host, yet it has only been known to reach maturity 
when eaten by the dog. 
Division B.—Taenia solium, i. It is found in man 
and the hog; and when matured gives off proglot- 
tides or the so-called joints, which, like the last seg- 
ment of the tape-worm of the dog, contains the gen- 
ital organs and the matured eggs. 2. These entire seg- 
ments, or only a part of the eggs, may find their way 
into the stomach from which, in an embryonic state, 
they migrate into the system, and there develop into 
the cysticercus cellulosae, which passes through a 
series of metamorphoses similar to that of the echi- 
nococcus. 
The so-called “measly” pork owes its peculiarities 
to the presence of these cysticerci, which, when eaten 
by man or other animals, will develop into a taenia 
solium, or tape-worm. Although we have two dis- 
tinct species of taenia which give rise to hydatid tu- 
mors, and furnish a wide field for study, yet we do 
not think a special study of either, except so far as 
they interest us clinically, is within the province of 
this paper; and would respectfully refer those who 
care to look up the subject in detail, to Kiichenmeis- 
ter or Leuckart. From a clinical standpoint it mat- 
ters but little which species is producing the intru- 
sion on the economy, the results to the patients are 
the same. 
It is true, as a rule, that the cysts or hydated tu- 4 
mors produced by the echinococcus are larger than 
those produced by the cysticerci, yet the latter make 
up for the deficiency in size by multiplicity in num- 
bers. When hydatid tumors are opened and their 
contents examined with the microscope they may be 
found to contain complete scolices or just the scat- 
tered hooklets of broken and incomplete heads. 
When scolices cannot be found free in the liquid of 
the cyst, they may be found by examining the brood 
capsule, or lining membrane of the same, except in 
the case of acephalocysts when no scolices or isolated 
hooklets can be found. These hydatid tumors con- 
tain a pale straw-colored fluid which usually contains 
no albumen, is freely charged with chloride of so- 
dium, and contains a liberal quantity of succinic acid, 
which is not unfrequently found combined with lime 
or soda; also, traces of grape sugar, together with 
other chemicals, are generally found present. 
Hydated cysts of one or the other of these taenia 
have been found in almost all parts of the human 
economy, but especially in the liver, the cellular tis- 
sue, the brain, the spinal cord, the eye, the spleen, 
the lungs, kidney, supra-renal capsules, heart, and 
even in the osseous system. 
Kiichenmeister, who collected 88 cases of cysti- 
cercus of the brain, found the cysts 49 times in the 
membranes, six of which were on the dura mater, 11 
on the arachnoid, 23 on the pia mater, and 9 on the 
choroid plexus. Fifty-nine on the surface of the cer- 
ebrum, 41 in the cortical substance, 19 in the white 
substance, 18 in the ventricles and aqueduct, 17 in 
the corpora striata and anterior commissure, 15 in 
the optic thalami and gray commissure, 4 in the cor- 
pora quadrigemina and the pineal gland, twice each 
in the trigona olfactoria, corpus callosum and medul- 
la oblongata, once in the olivary body, and 18 times 
in the cerebellum. In the above, 18 per cent, were 
without any symptoms, in 6 they were only trifling, 
in 5 epilepsy alone was present, in 4 epilepsy with 5 
mental debility, in 15 epilepsy with paralytic symp- 
toms, in 24 insanity without epilepsy, of which 7 were 
without motor or sensory disturbances, 17 had lame- 
ness, cramps, hemiplegia, paralysis and muscular 
twitchings, while out of all only 24 had epilepsy. 
The si/e and growth of these hydatid tumors va- 
ries according to the space afforded them for devel- 
opment. It seems that their si/e depends more on 
the pliability of the tissues, rather than the quantity 
and quality of the nourishment furnished. The dan- 
ger attending the presence of these hydatid tumors 
depends very much on their location and si/e. When 
they occur in the subcutaneous cellular tissue it is 
not attended with any great danger. I know of a 
young man who is under the care of my friend Dr. 
J. W. Craig, in whom they can be counted by the 
hundreds, notwithstanding the doctor has cut out 
several scores already, and yet the young man is ap- 
parently in good health. When they occur in the 
muscular tissue they become more and more inju- 
rious in proportion to their depth and the importance 
of the structures involved. Their occurrence in the 
anterior chamber of the eye may not occasion any 
grave symptoms, but when they occur in the poste- 
rior chamber, the vitreous, the retina, or under the 
retina, as observed by Sommering, Schott, von 
Graefe, Mackenzie, Baum, Esthlin Sickel, and others, 
they produce the most serious trouble. When they 
locate themselves in the brain or its membranes, they 
occasion a multitude of symptoms, which are modi- 
fied by their location, as will be best observed in the 
cases I am about to report in this paper, and which, 
it will be readily observed, renders the diagnosis ex- 
ceedingly difficult and obscure. 
Case I.—Dr. B., set. 46, a large, strong, hearty man, who 
was engaged as a traveling doctor, was taken ill in the summer 
of 1880; at first was easily fatigued, mentally and physically, 
but able to be up and around and practice his profession, which 
was soon followed with general malaise, which gradually grew 6 
worse until he had lost all inclination for business; this was fol- 
lowed by gradually increasing vertigo, could not sit upright long 
at a time, which became so bad as to almost disable him from 
walking across the room, or sitting up at all; when he attempted 
to walk would pitch forward on the face. As the disease grew 
worse he was taken with vomiting, with or without food, which 
assumed a reflex character. From the first there was a constant 
tendency for the head to drop forwards, and toward the last, 
when not lying down, would sit with the head dropped forward, 
which tendency manifested itself even when lying down. He 
was extremely nervous, and toward the last his appetite, which 
had gradually failed him from the first, failed entirely, ex- 
cept that he had an incessant desire to drink milk, which was im- 
mediately vomited after entering the stomach. The bowels were 
regular and urine normal. There was a gradually increasing 
stupor, with some mental aberration toward the last, which con- 
tinued, together with an increase of all the other symptoms, un- 
til the patient died from collapse March 3d, 1881. The post- 
mortem revealed sclerosis of the gray portion of the brain, with 
softening in the right cerebellum and in both ventricles. In the 
right lateral ventricle was found a hydatid tumor the size of the 
first joint of a man’s thumb, which was surrounded with some 
pus and considerable effusion. 
Case II.—J. W. K., aet. 28, a strong, hearty laborer, was 
taken sick in spring of 1879 with pain in the left side. No dif- 
ficulty with the hearing, complained of trouble from coughing 
with pain in the chest; partial paralysis of right arm. In Feb- 
ruary, 1881, had a similar attack ; also one in 1882, which was 
followed with another in December, 1883, when he commenced 
to have an offensive discharge from the left nostril. In May 
(23d), 1884, he was taken with a chill, followed with pain in the 
left side of the head. Had a troublesome cough of a nervous 
character ; appetite good, which continued to the last, with no 
vomiting ; bowels regular ; no alteration of the temperature, 
tjut some nervous excitability of the pulse, which would often 
rise above or drop below the normal, and in a short time return 
to the normal again. Would often complain of a cold spot on 
the top or left side of his head. Was troubled at times with 
diplopia, and flashes of light in both eyes. Had been able to 
do manual labor, however, between each of the other attacks, 
and even up to the commencement of this last attack, at which 
time he had an exaggeration of all the former symptoms except- 
ing the paralysis ; but more especially the pulmonary symptoms, 
which gave rise to coughing and dyspnoea. These symptoms in- 
creased until he died from general exhaustion June 1st, 1884. 
Assisted by Dr. J. Harvey Craig I made a post-mortem five 
hours after death, and found a large hydatid tumor located in 7 
the left lateral ventricle, nearly as large as a hulled white walnut. 
There was considerable effusion, with softening and destruction 
of the brain substance on the left side, and thickening of the 
membranes of the cerebellum and spinal cord, with here and 
there spots entirely destroyed by softening. An examination of 
the rest of the body revealed nothing of an abnormal character. 
Case III. —O. H. B., set. 52, a strong, robust man, was ac- 
customed to doing considerable mental and physical labor. 
Commenced complaining in the spring of 1882, with general 
debility accompanied with some dyspncea and difficulty in deg- 
lutition, but had no trouble digesting his food after getting it 
swallowed ; bowels were normal, and urine natural at first, but 
contained some albumen toward the last. Was advised to take 
a trip for his health, but returned feeling worse ; both the asth- 
matic symptoms and the difficulty in swallowing were much 
worse. His gait became unsteady and staggering, but no par- 
alysis, and mind clear and no tendency to spasms. These symp- 
toms gradually became worse until the patient died of exhaus- 
tion December 30, 1883. The post-mortem showed evidence 
of athoromatous degeneration of the cerebral arteries, more 
especially those in the circle of Willis, but little effusion. Two 
hydatid tumors were found in the right lateral ventricle, and 
three in the left lateral ventricle, varying in size from a grape 
down to that of a pea. 
Case IV.—Mrs. McS., set. 57, an ordinarily healthy female, 
had been married and raised a family, but was now a widow ; 
had “changed life” at the age of 50. Had not been feeling 
well for some time, but commenced to grow worse in 1877, when 
she was very much debilitated ; some mental aberration, among 
the first of which was that of imagining she smelt the fumes of 
a tobacco pipe. She next became contrary in almost every- 
thing, which was the more noticeable on account of her pre- 
viously agreeable disposition ; she imagined every person wanted 
to poison her. Her general lassitude increased, her gait became 
staggery, and she soon lost all ability to maintain the upright 
position, and when attempted, had a tendency to pitch forward ; 
complained constantly of a cold spot on the top of her head. 
She had a constantly sick stomach, with vomiting only toward 
the last ; a constant desire to urinate, was very thirsty and drank 
a great deal; had some fever at times in the latter part of her 
illness ; toward the last the pain in the head subsided ; had great 
difficulty in deglutition, very great dyspncea, some paralysis on 
the right side. A week before she died became blind and deaf, 
with complete aphasia, and finally went into a comatose condi- 
tion and died March 12th, 1884. The post-mortem revealed 
two hydatids in the right and three in the left ventricle, with 
marked cerebral effusion and general softening of the entire 
brain substance. 8 
For the first, third and fourth cases I am indebted 
to my personal friend and fellow-townsman, Dr. J. 
W. Craig, although the writer was present at the ne- 
cropsies of all excepting case No. Ill, but had the 
pleasure and profit of examining the tumors removed 
in that case. 
In our opinion, the first and second cases were 
produced by the ecchiuococcus, while the third and 
fourth were the result of the cysticercus cellulosa. 
By permission I quote from a private letter received 
from Prof. Wm. Pepper, of the University of Penn- 
sylvania, in which he says: “ I have met with two 
cases, but unfortunately, the clinical records are so 
imperfect that I shall not publish them. The autop- 
sies were, however, carefully performed. There was 
one hydatid in the retina in one case, with a cyst in 
the right anterior lobe of the brain. In the other the 
cysts were found on the left side of the base. They 
were both hospital cases, and no record could be 
obtained as to their previous history. The one is 
undoubted as to its character, while in the other it is 
believed that the cysts were hydatid from their gen- 
eral gross appearance.” 
For a number of the following synopses of inter- 
esting cases of hydatids of the brain and spinal cord, 
I am not only indebted to my personal friend, I)r. 
N. Senn, of Milwaukee, for kind assistance in col- 
lecting them, but also for their translation; also to 
Dr. Robert Herdegen, of Milwaukee, for his assist- 
ance in the same. 
Dr. J. Klob reports two cases of cysticercus cellu- 
lose in the brain, in the Vienna Weekly, Nos. 8 and 
9, 1867. The first case was that of a man aged 54, 
who two years previously suffered from rheumatic 
pains in the lower extremities. For some time grad- 
ual loss of memory. Pupils somewhat dilated; speech 
slow, but plain; difficulty in hearing; movements of 
the upper extremities slow and with effort; toward 
the last the patient was troubled with incontinence 
of urine, lower extremities paralyzed. A post-mortem 9 
examination showed the dura mater to be tense, brain 
swollen, left hemisphere of the brain somewhat larger 
than the right. On opening the left lateral ventricle, 
a large cyst with delicate walls escaped, which con- 
tained a clear, watery fluid. The cyst was as large 
as a medium-sized apple. From the under surface a 
pedicle of gray color was given off, to which two 
smaller cysts were attached. A peculiar pigment 
was observed, arranged symmetrically, in the centre 
of which were found the hooklets of the cysticercus. 
The second case was a woman 43 years of age, who 
after intense fright suffered from severe headache, 
and a few days later was seized with convulsions. 
These convulsions appeared at short intervals, and 
assumed an epileptiform character. The convulsive 
movements affected mostly the left side of the body. 
On the eleventh day of illness she died, death being 
preceded by collapse and stupor. On post-mortem 
examination the dura mater was found tense. In the 
pia mater, over the right cerebrum, were found chalky 
nodules, which were identified as cysticerci which had 
undergone calcification. On the lateral surface two 
recent cysticerci were found. In the posterior por- 
tion of the right side of the brain a closed cavity the 
size of a walnut was found, which communicated 
with another cavity the size of a pea by a narrow 
channel. At the point where both of these cavities 
joined was found a calcified cysticercus. 
Urs. W. and G. Markle report a case of cysticer- 
cus cellulosa in the cerebellum in the German Arch- 
ives of Clinical Medicine, vol. iii, p. 297, in which 
the patient was a strong boy of 13, who was taken 
ill with severe pain and stiffness of extensor muscles 
of the neck, which abated slowly and imperfectly. 
After a few months, severe attacks of headache were 
complained of, which were accompanied at times by 
vomiting. These severe attacks were succeeded by 
sleep resembling stupor. Death occurred suddenly. 
The post-mortem revealed in the left lobe of the 10 
cerebellum a tumor the size of a hazel-nut, with a 
resistant yellow nucleus. The entire white substance 
of the cerebellum was softened and gelatinous. The 
swelling was surrounded by a layer of pus i mm. 
in thickness. The tumor consisted of a cyst, which 
contained detritus, in the centre of which a well pre- 
served cysticercus was found. 
A similar case is reported by G. Markle, in the 
person of a boy years old, previously in robust 
health, who was taken ill with headache and vomit- 
ing. In one of these attacks of headache he became 
restless and delirious, which was followed by uncon- 
sciousness, stupor and death. At the necropsy, a 
cyst the size of a cherry was found in the infundibu- 
lum, which proved to be a cysticercus cellulosa. The 
gyri of the brain were flattened, the consistency of 
the white substance was firm. 
Dr. Marks, in writing of the echinococcus in the 
brain (Virchow in Hirsch’s yearly report, 1873, vol. 
I, p. 640) reports a case of echinococcus in the brain 
which is of interest on account of its location in the 
left temporal lobe of the brain. The patient, who 
was 40 years of age, had had an attack of dizziness 
during the month of December, 1871. In July, 1873, 
he was seized with another attack, which was followed 
with facial paralysis of the right side, complete para- 
lysis of the left upper extremity, partial paralysis of 
the left lower extremity. Sensation in both right arm 
and leg diminished. His condition both mentally and 
physically gradually became worse, especially the 
aphasia. He at last passed into a stupor, had incon- 
tinence of urine, followed by death. The autopsy 
showed great tensity of the dura mater, the convolu- 
tions of the cerebrum were flattened, but more on 
the left than on the right side. On the outer side of 
the left temporal lobe a green discolored spot the size 
of a dollar was found, below which, at the depth of 
2 mm., an echinococcus cyst the size of a fish was 
found, which contained a clear fluid. The cyst could 11 
be removed with ease from the substance of the 
brain. The right half of the pons was flattened, while 
the remaining portions of the brain were not materi- 
ally changed. 
Griesinger, who has collected over 70 cases of 
these parasitic affections of the brain, 54 of which 
he describes minutely, 21 of which were his own 
cases, found their occurrence in the spine very rare, 
of which Dr. Otto Hebald reports two very interest- 
ing cases, which are recorded in vol. XV, No. 3, p. 
812, of the Arc/iiv fiir Psychiatrie, Berlin, 1884; for 
the translation of this, from which I only give a synop- 
sis, I am indebted to Dr. Henry Ruess, of Mansfield, 
Ohio: 
The first patient was an idiotic female, aged 63, of 
healthy parentage, but who had an idiotic half-sister. 
Early in life she became hysterical. Seven years ago 
was troubled with hallucinations, a year later was 
taken with epileptic convulsions, which occurred fre- 
quently, together with vomiting, two years later 
became blind, with partial paralysis, and perverted 
sensibility, difficult articulation, general depression, 
followed by death. The autopsy revealed cysticerci 
under the pia mater of the spine and brain, also in 
the cortex of the latter. One was found free in the 
lateral ventricle, also one in the muscle of the heart, 
and under the pleura costalis. 
In the same article he reports another case which 
occurred in a female aged 65, who was of an irritable 
disposition, especially during the menstrual period, 
who was taken ill in 1876, showing signs of brain 
irritation, with hallucinations in hearing. At times 
had attacks of religious exaltations, at others tore her 
hair, and at times was very destructive. After being 
removed into the asylum her symptoms grew worse, 
would inflict injuries upon herself and others; she was 
exceedingly filthy, would eat her own and others’ 
feces. In 1877, symptoms of pressure on the brain, 
with epileptic attacks, with unconsciousness, had 12 
vomiting of green matter, slight paralytic symptoms 
in the right upper extremity. Her condition, with 
occasional short improvements, gradually grew worse, 
which was attended with difficult articulation. In 
1879 partial and total blindness set in ; from that time 
to 1881 and 1882 paralysis of lower extremities; 
toward the last, in 1883, had to be carried around. 
Epileptic attacks preceded her death, which occurred 
in the summer of 1883. The autopsy revealed cysti- 
cercus the whole extent of the dura spinalis as high 
as the first dorsal vertebra, also over the right ante- 
rior and lateral division of the medulla. Marked 
adhesions of the dura to the cranium. Scattered 
under the membranes and over the brain in both lat- 
eral ventricles were cysts of the cysticerci from the 
size of a pea to that of a bean, which were filled 
with a clear yellowish liquid. Also in the right pos- 
terior wall of the chest, under the pleura, were found 
four cysts about the size of a bean, also one under 
the left pleura costalis. The writer observed that 
only those in the ventricles were well developed, the 
rest were imperfectly developed, and that those in 
the substance of the brain were smaller, and had a 
tougher capsule. A few reached into the white sub- 
stance of the brain, but not a single one was found 
there alone; the majority being in the cortical sub- 
stance of the brain, in different parts of it. After 
making a careful analysis, the author arrives at the 
conclusion that the case was primarily one of insan- 
ity, which led to the eating of feces, by which she 
became infected with the cysticerci, which developed 
a new train of symptoms still later, which subse- 
quently produced death. 
Ulrich, in abstract in Virchow, 1872, No. 2, p. 16, 
reports a case of cysticercus in the brain and spine 
both, in an insane person. Regarding this case, he 
says the insanity was not caused by the cysticercus, 
but the cysticercus was the result of the extremely 
filthy habits of the person. 13 
Yates—abstract in Virchow, 1870, No. 2, p. 60, 
reports a case of a young man who died at the age 
of 21, who was under his care for two years previous 
to his death, and complained of headache, weakness 
of legs, hemiplegia, light delirium and stupor, fol- 
lowed by death. Autopsy revealed a hydatid tumor 
the size of an ostrich egg in the left hemisphere of 
the cerebrum. The patient died suddenly, but not- 
withstanding his stupidity, he was able to answer 
questions intelligently up to the time of his death. 
Sutherland—in Virchow, 1873, No. 2» P- 67, reports 
the occurrence of an echinococcus between the 
chiasm and pons, with compression of the two oculo- 
motors, and destruction of the ventricles. His symp- 
toms were intense headache, frequent vomiting, tinni- 
tus aurium, deafness, and impaired vision. 
Schlott—in Virchow, 1873, No. 2, p. 68, reports a 
case occurring in a former soldier, who took sick with 
frequent fits of giddiness, headache, nausea, and 
heaviness of his limbs, tongue blue and swollen, oscil- 
lations before the eyes, diplopia, staggering gait. 
His bodily and mental capabilities grew weaker, first 
vomiting and regurgitation, afterward would swallow 
with great avidity. Spontaneous discharge of faeces 
and urine, his language became stammering, choreic 
movements, subsultus tendinum, and finally died with 
pulmonary oedema. The autopsy revealed number- 
less cy-sticerci, from the size of a pin-head to that of 
a pea, in the dura over the base of the brain, as well 
as in the dura of the cerebrum, in the substance of 
the cerebrum and cerebellum, and also on the surface 
of the same, and in the ventricles and in the great 
ganglions, besides, they were even found in the mus- 
cles throughout the body. 
Westphal—in Virchow, 1873, vol. 2, p. 68, reports 
an interesting case, with recovery, of echinococcus 
observed in the Charite, in Berlin, in a young man 
aged 17. The symptoms were headache, nausea, 
right exophthalmus, and protrusion of the right tern- 14 
poral bone, hemiplegia on the left side. These symp- 
toms came on step by step, with exacerbations and 
remissions. The protrusion of the right parietal 
region became large, extending to the vertex. In 
four weeks after he entered the hospital, by the 
finger one could feel a perforation of the bone about 
an inch above the outer angle of the right eye, four 
days later there was another perforation near the first 
one. By and by, from these openings a fluctuating 
tumor appeared under the skin, and the tumor was 
diagnosticated echinococcus. An exploratory punc- 
ture failed, and an incision was made, which soon 
discharged about ninety cysts. Ten days later, by 
blowing his nose there came out of the left nostril a 
large and two smaller cysts. When the patient left 
the hospital a few weeks later, he was free from head- 
ache and hemiplegia, but the circumference of the 
right side was three inches larger than the left, and 
the exophthalmus still continued, with blindness. 
The openings in the bones still existed, the pulse 
varied from go to 150, with a normal temperature. 
Eichorst, vol. II, page 708, says the echinococcus 
usually consists of but one cyst, seldom multiple, but 
in the case of Espinosa there were 52 cysts under 
the arachnoid membrane. 
The frecpiency of this disease depends on at least 
three factors: 1, The prevalence of making dogs 
household pets, as in Iceland, where it is estimated 
by some writers that at least one-tenth of the popu- 
lation suffer from echinococci, which is undoubt- 
edly due to this cause. 2, The eating of half-cooked 
“measly pork,” which gives rise to numerous tape- 
worms, and they in turn to the cysticerci. 3, The 
filthy habits of many, together with the increase of 
population, which necessitates the close commingling 
of all classes. 
Hydatid tumors are found to be more frequent in 
old persons than in young persons, although they 
may occur at any age, and are more apt to be found 15 
among the poorer members of the population than 
among those in affluent circumstances, but sex does 
not appear to make any difference as to their fre- 
quency. The tape-worm and its embryo may exist 
in the same person at the same time, or a tape-worm 
and the echinococcus may exist in the same subject 
at the same time, but a tamia echinococcus and its 
embryo never has been known to exist in man at 
the same time. The prognosis in this disease as a 
rule is unfavorable when it is intra-cranial; only a 
few such cases of recovery are on record. 
The treatment of these cases is also very unsatis- 
factory so far as therapeutic remedies are concerned. 
The salts of mercury and iodide of potassium have 
been, however, liberally used, with a view of destroy- 
ing them by their antiparasitic effects, as well as for 
their alterative virtues. Tr. of kamala, in doses of 
from 30 to 40 drops three times a day, has been used 
freely with some reputation for good. Electricity 
has filled its place in the catalogue of remedies used 
in this malady with a questionable reputation. 
When accessible the most positive benefits are 
derived from surgical interference, by which the cysts 
are emptied, by laying them open with the bistory; 
and now that surgeons are beginning to deal with the 
brain, as with other parts of the human economy, 
and more and more liberties are taken with it an- 
nually, it is hoped that sufferers from this dreadful 
disease may find a source of relief ere long at the 
hands of the skillful surgeon. 
Although this disease, except in Iceland, is com- 
paratively rare, and perhaps more so in America than 
in continental Europe, yet Dr. Osier states, in regard 
to the echinococcus disease in America, that he has 
collected from various sources 61 cases. (See trans- 
actions of Canada Med. Association, 1882, p. 354.) 
With the steady increase of our population, unless 
active preventive measures are inaugurated we 
must expect a corresponding increase in this disease, 16 
which will steal in on us as a thief in the night, and 
cause many a premature death, unless we remove 
the causes which favor its production and develop- 
ment, viz: Dogs as household pets, the use of half- 
cooked unhealthy pork, together with all general un- 
sanitary surroundings. 
April 20th, 1885.