Chapter XII: Section II: CESTODA (Tapeworms) (4)

As the scope and tendency of this work preclude the textual admission of clinical details, I must limit my remaining observations to the pathology of hydatid disease. At very great labor, pursued at distant intervals during a period of ten years, I sought to ascertain the probable extent and fatality of this form of parasitism in England, by going over such evidence as our pathological museums might supply. Although, from a statistical point of view, the investigation could hardly be expected to yield any very striking results; yet clinically viewed the study was most instructive. The evidence which I thus procured of numerous slow and painful deaths from echinococcus disease, further stimulated me to place a summary of the facts on record. Physicians, surgeons, scientific pathologists, and veterinary practitioners are alike interested in the study of hydatid disease; and I had not proceeded far in my careful investigation before it became evident to me that very great practical results would ensue if, in this kind of effort, the principle of division of labor had full play. At all events, within these museums lie concealed a mass of pathological data which, although well within reach, have not been utilised to the extent they ought to have been.

As a student of parasites for some thirty years, I must without offence be permitted to protest against the too frequent omission of parasites in statistical evidence as a cause of mortality. From facts within my own knowledge I can confidently assert that parasites in general, and hydatids in particular, play a far more important part in the production of disease and death than is commonly supposed. In saying thus much, however, I am not insensible to the fact that, in recent times, new methods of treatment combined with higher surgical skill, have greatly tended to lessen the fatality of this affection. In this connection I would especially refer to the recorded experiences of an able colonial surgeon, Dr MacGillivray, as made known in the pages of the ‘Australian Medical Journal.’ The able surgeon to the Bendigo Hospital, treated as in-patients, from 1862 to 1872, inclusive, no fewer than seventy-four cases of hydatid disease. He operated on fifty-eight of them. Two patients were tapped for temporary relief (as they were dying of other diseases); and of the remaining fifty-six only eleven died. No fewer than forty-five were discharged _cured_--a fact redounding largely, I should think, to the credit of Australian surgery.

In reference to museum evidence I have no hesitation in saying that the pathological collections in the metropolis abound in rare and remarkable illustrations of hydatid disease; most of the preparations being practically known only to such few members of the medical profession as have been at some time or other officially connected with the museums. Not without justice, curators often complain that their work and catalogues are turned to little account. As a former conservator of the Edinburgh University Anatomical Museum (1851-56), and subsequently as museum-curator at the Middlesex Hospital Medical College, I am in a position to sympathise with them. Valuable, however, as the catalogues are, it is often necessary to make a close inspection of the preparations in order to arrive at a correct interpretation of the facts presented.

Although the entozoal preparations in the museum attached to St Bartholomew’s Hospital are, comparatively speaking, few in number, there are some choice specimens of hydatid disease. There is a remarkable case in which hydatids invaded the right half of the bones of the pelvis; death resulting from suppurative inflammation of the cysts. This patient, a woman, had also another hydatid cyst which was connected with the ovary. Amongst the series contributed by Dr Farre, there is a case represented where a large cyst containing numerous hydatids “occupied the pelvis of an infant and produced retention of urine,” which ultimately proved fatal. There are also several fine examples of hydatids from the omentum (Dr Farre’s case), besides a good specimen of acephalocysts connected with the vesiculæ seminales. There are two other cases in which these larval entozoa were passed with the urine. At the time when I made my inspection, the entire series represented twenty-five separate cases, of which only one appears to have been published in detail (Mr Evans’s case, ‘Medico-Chirurgical Transactions,’ 1832). In addition to the above, I must not omit to particularise two instructive preparations illustrative of a case in which an hydatid was lodged in the right half of the cerebrum. This was from a girl in whom head symptoms showed themselves a year before death, and in whom there was partial hemiplegia of the left side. I may add that there is also in the series a doubtfully genuine example of hydatids of the breast.

The collection in connection with the Westminster Hospital contains several highly interesting specimens of entozoa (one of which I believe to be altogether unique), but it is by no means rich in the matter of hydatids. Out of a score of preparations of parasites of various kinds, only four (apparently representing the same number of cases) are hydatids, all of which appear to have been connected with the liver. Two are certainly so, one of the latter (Mr Holthouse’s case) showing calcareous degeneration.

The museum connected with St Mary’s Hospital Medical School, in addition to several liver cases, contains one interesting example of hydatids of the lung (Dr Chambers’s case), and also three valuable preparations illustrating Mr Coulson’s remarkable case of hydatids affecting the tibia. One of the preparations shows the bone itself, which was eventually removed at the joint, the operation having been performed by Mr Spencer Wells.

Here, perhaps, it will not be out of place to mention as a fact of special clinical interest that I have encountered records of no fewer than nine other similar cases where hydatids have taken up their abode in the tibia, generally selecting the head or upper part of the bone. Some of my notes have been mislaid, but, speaking from recollection, one of the choicest specimens which I have examined is that contained in the pathological museum of the Nottingham Hospital.

When I first went over the collection of the Middlesex Hospital Museum, I found it to contain fifty-four preparations of entozoa, of which some fourteen only were true hydatids, representing as many separate cases. There are now upwards of a score of preparations of hydatids, several of the cases having already had ample justice done to them by Dr Murchison in his well-known memoir (‘Edinb. Med. Journ.,’ Dec., 1865). Amongst the most interesting preparations I would especially call attention to two fine and genuine specimens from the kidney, another very large example of an hydatid situated between the bladder and rectum, a simple acephalocyst removed from the orbit (Mr Hulke’s case), and the hydatid removed from the axilla by the late Mr Charles Moore. There is a jar containing hundreds of hydatids that were taken from the thoracic cavity of a dissecting-room subject, who was reported to have died of phthisis; and there is another preparation of an hydatid of the heart, which also proved fatal, without there having been the slightest suspicion entertained as to the true nature of the disease. For this fine preparation the museum stands indebted to Dr Moxon, of Guy’s Hospital. Several of the liver cases are particularly instructive; but amongst the specimens presented by Mr Mitchell Henry is a small bottle full of minute hydatid vesicles, all of which were removed from the interior of the tibia. The history of this case has been lost; and, unfortunately, the bone from which the parasites were taken does not appear to have been preserved.

The museum connected with King’s College contains at least a dozen good specimens of liver hydatids, several of the cases being of special interest from a pathological point of view. There are two remarkably fine examples of hydatids contributed by Dr Hooper, the parasites in one case affecting the spleen, and in the other involving the ovary and uterus. The spleen contained numerous encysted hydatids, whilst the uterine organs exhibited “an immense collection” of the same growths. In this place, also, I may refer to an hydatid-like entozoon, taken from a cyst in the ovary of a female who had been under the care of Dr Johnson (1860). It is, apparently, a genuine example of the slender-necked hydatid (_Cysticercus tenuicollis_); and if so (as might be determined by dissection), is, so far as I aware, the only specimen of the kind in existence from the human bearer. There is a renal hydatid (presented by Dr Pass, of Warwick) which was obtained from a lunatic, its presence being “quite unsuspected during life.” Amongst the liver cases (the majority of which are from Dr Hooper’s collection), there is one enormous hydatid that was obtained from a young woman who had died during a fit of laughter. The tumour had pushed the diaphragm up to a level with the fourth rib; and it is stated that, on puncturing the cyst, the fluid contents were ejected “in a jet nearly two feet high.” There is one case represented where numerous hydatids were expectorated after hepatitis, whence it was concluded that they were originally connected with the liver. There is a large solitary hydatid that was removed from a young female who died of phthisis, and in whom the consequent swelling had formed in the neighbourhood of the navel. Especially instructive, also, from a clinical point of view, is a case of peritoneal hydatids where the tumours had been diagnosed to represent a case of extra-uterine fœtation. It appears that there were two cysts, one of them being connected with the uterus. Two of the enormous hydatids taken from these cysts are preserved in the collection of the Anatomy School of Oxford. Several of the preparations show to perfection the stages of natural cure produced by calcareous degeneration; and there is one liver showing three of these so-called ossified cysts. The disease in this case proved fatal.

Most of the entozoa displayed in the Charing Cross Hospital Museum have been contributed by Dr Wiltshire, the series being particularly strong in tapeworms. There are four characteristic examples of hydatids of the liver, representing as many separate cases. Two were from abscesses of this organ. In one of these, Mr Canton’s case, the hydatid was, I believe, expelled after operation; but in the other example (presented by Mr Rose, of Swaffham) the parasite was evacuated from an abscess, which burst of itself, externally.

In the museum at University College, I examined sixteen preparations of hydatid disease, representing almost as many distinct cases. One is a wax model. Eight of the specimens were from the liver, five from the abdomen (including those of the omentum and mesentery), two from the lungs, and one from the heart. The model displayed ordinary hydatids of the liver bursting into the lungs. The mesenteric example is particularly fine, whilst that from the omentum is undergoing calcareous degeneration. Probably the most interesting of all is the example showing an hydatid lodged in the septum of the heart. This was from a middle-aged female, who died suddenly whilst pursuing her ordinary domestic avocations.

The museum of the Royal College of Surgeons contains a fine collection of parasites, its chief strength in this respect being due to the special series of entozoa. Were visitors to judge by the contents of the catalogue of this series (which I prepared some years ago at the instance of the Council of the College), they might be led to suppose that the hydatids were only feebly represented. Out of nine preparations of hydatids in this section, only six have come from the human body. However, scattered throughout the collection, I found that there were no fewer than thirty-five preparations of hydatids belonging, apparently, to as many as thirty separate cases. Omitting, for the present, all mention of these derived from animals, I ascertained that, of the thirty human cases, thirteen were referable to the liver, four to the abdomen, three to the lungs (one of which was originally connected with the liver), and two to the brain. Five were of uncertain seat. With the abdominal cases we may also include one case of hydatids of the spleen, and another where these organisms were found in the region of the bladder. There is a characteristic breast case. One of the original Hunterian cases (in which “a prodigious number of hydatids were found in the sac of the liver and dispersed throughout the cavity of the abdomen”) appears, though it is not expressly so stated in the catalogue, to have been regarded as an ordinary example of abdominal dropsy. In one of the three lung cases two small hydatids were separately expectorated at an interval of about a month. This occurred in a female.

I may here incidentally remark that many cases are on record where abdominal hydatids have been overlooked, the patient being supposed to be suffering from ascites. One such instance took place a few years ago at the Middlesex Hospital. I well remember a similar case of supposed hydrothorax, where the post-mortem examination revealed the presence of immense numbers of these formations occupying the right side of the chest. This case occurred at the Norfolk and Norwich Hospital, at the time when I was a student there, some thirty-five years ago.

The pathological collection connected with St George’s Hospital displays several good hydatid preparations, the entire series representing at least twenty-two separate cases. Of these, fifteen are referable to the liver, that is, if we include Dr Dickinson’s case, already published, where hydatids were found within the hepatic duct. There are two renal cases; also one from the brain (Dr Dickinson’s case), and another where an hydatid was expectorated. Besides these, there are three other highly characteristic examples of echinococcus disease affecting the region of the neck, breast, and axilla respectively.

The museum of the London Hospital Medical School contains a large collection of parasites. Out of fifty-seven preparations of entozoa, I found twenty-two referable to hydatids; and, so far as I could gather, all of them belonged to different cases. Only one case seems to have been published in detail. This, though a very old preparation, is a fine example of an hydatid, nearly three inches in length, occupying one of the cerebral hemispheres (‘Edinb. Med. Journ.,’ vol. xv). There is a second brain case, where the vesicles were of small size, but very numerous. Of the other twenty cases, fourteen belong to the liver, two to the spleen, one to the lung, one to the uterus; one being a very large hydatid of doubtful seat, and another being referable to the lumbar region, where it formed a tumour containing “a large number of small hydatids.” Amongst the more remarkable specimens is that described in the MS. catalogue as “a true hydatid cyst developed in connection with the broad ligament.” This preparation, unique of its kind, shows no trace of the ovary, which, indeed, seems to have disappeared altogether. One of the liver cases should rather be classed as abdominal, since the large cyst is situated between the diaphragm and liver, pressing upon the latter organ below and also upon the lung above, but apparently not involving either of these viscera structurally. Another very striking case is that in which there is an external opening communicating with the cyst in the liver, and an internal opening through the diaphragm communicating with the lungs and bronchial tubes. The patient had actually coughed up liver hydatids by the mouth, and had passed others through the right wall of his abdomen. There is another liver case in which the hydatids, in place of escaping externally, had gained access to the inferior cava; and if I understand the MS. record rightly, in the same patient a second hydatid communicated with the portal vein, and a third with the hepatic vein. Lastly, I must add that there is yet another fine preparation of liver hydatids, occurring in a lad, nineteen years of age. He had, it seems, met with “a slight accident, and died with obscure head symptoms;” but the odd part of the case is that at the post-mortem examination there was positively nothing found that could explain the patient’s death. He was under the care of Mr Luke (1834).

Comparatively recently I inspected the collection at St Thomas’s Hospital, which I found to be particularly rich in entozoa of various kinds, especially tapeworms and hydatids. I encountered seventy-six preparations of internal parasites; and of these, forty-two were of the hydatid kind, representing at least thirty-three different cases. I say “at least,” because it is often impossible to decide in instances where no history of the specimens can be obtained. Thus, there are three similar preparations of hydatids passed by the urethra, and, from their appearance, I judge them to have come from one and the same patient; yet there is no statement in the catalogue to that effect.

Of the thirty-three cases of hydatids represented in this museum, I reckoned eighteen as referable to the liver, two to the brain, two to the bones, two to the urinary organs, and one to the lung, spleen, uterus, and soft parts of the thigh respectively. There are also three that may be classed as peritoneal. There is another choice example in which the disease cannot be referred to any particular organ. I allude to Dr Peacock’s case, already published (‘Pathological Transactions,’ vol. xv), where the lungs, liver, heart, spleen, and some other organs, were all occupied by hydatid formations. As an instance of extensive visceral infection by Echinococci in the human subject, I believe this case to be unique. The brain hydatids are particularly fine. In the specimen presented by Mr Boot, of Lincoln, the hydatid, two inches in diameter, is lodged in the anterior horn of the left ventricle. One of the peritoneal cases is remarkable for the amount of forward displacement of the pelvic viscera, caused by four or more hydatids, each of them nearly as large as a cricket-ball. Amongst the abdominal cases I have included a recent preparation, to which Mr Stewart has called my attention. The hydatid in question, of the size of a large lemon, existed near the fundus of the bladder, its walls being one third of an inch in thickness, and forming an unusually firm tumour. Of all the fine specimens of hydatids in the collection, however, none have struck me so much as those affecting the bones. There is a humerus, taken from a man thirty-four years of age, in which the shaft is occupied throughout by small hydatids that have destroyed almost all the cancellous structure; in some places, also, the absorption of the cortical layer has gone on to such an extent as to have left little more than the periosteum. Of course, the bone was at last fractured easily. It is a beautiful specimen; and the existence of Echinococcus-heads was proved by microscopic evidence. Scarcely less interesting are two preparations illustrative of Mr Traver’s case of a man, thirty-eight years of age, in whom numerous small hydatids occupied both the head of the tibia and the lower end of the femur. Each set of parasites freely communicated with the knee-joint, necessitating amputation of the limb.

The very large museum connected with Guy’s Hospital is rich in hydatids. When, some time ago, I spent several days in going over the collection, I examined seventy-six preparations, representing apparently seventy separate cases of this affection. Amongst the noteworthy specimens one lung hydatid was intimately associated with a thoracic aneurism, two others being connected with the pleura; and of seven abdominal cases, five were connected with the peritoneum, one with the mesocolon, and one with the aorta. This last-mentioned instance occurred in a woman of sixty years, who, until her death, was treated for dropsy. She complained of incessant pain, which was only relieved when she rested on her hands and knees. Of the three cases affecting the heart one has been published (Mr Henderson’s), where the patient, a girl of nineteen years, died suddenly whilst in the apparent enjoyment of perfect health. In one of the other two cases (Mr May’s, of Tottenham), the left lung was also involved. One case of hydatid disease affecting the spinal column appears to have been originally an ordinary liver case. In Mr Cock’s example of genuine mammary hydatids, the hooklets and echinococcus heads were detected; but I am not sure that a similar result of microscopic examination was obtained in the equally interesting example of hydatids of the thyroid gland (also removed by Mr Cock). There are five bladder cases, all apparently genuine (of which one has been published); and there are also five other cases referred in the catalogue to the kidneys, of which I regard two as doubtfully parasitic in character. Of three cases of hydatid growths occupying the soft parts of the thigh, two were under Mr Bryant’s care. The museum likewise contains an old preparation of hydatids of the tibia, but its history has been lost. There are also two brain cases, besides upwards of a score of more or less characteristic and instructive cases of hydatids affecting the liver.

Scattered amongst the museums connected with the larger provincial schools and recognised hospitals there must be a great many valuable preparations of hydatid disease; at all events, I judge so from the inspection I have incidentally made of a few of the collections.

Of eleven preparations of human hydatids which I observed in the Cambridge Anatomical Museum, apparently representing the same number of cases, seven were connected with the liver and one with the lungs. Those hydatids displayed in the “special series” of entozoa were of uncertain seat. From the recently published and valuable ‘Notes’ by Dr Bradbury, I have no doubt that considerable additions have been made to the Cambridge Collection since my last visit.

The museum at Oxford contains some choice specimens of hydatids, but I have only personally inspected a few of them. In the absence of original notes, however, I am indebted to the kindness of Mr W. Hatchett Jackson for supplying me with several interesting particulars. The anatomical department of the Oxford Collection shows from one particular case two hydatids that were found “under the dura mater.” In the pathological department we find one hydatid from the liver of a male subject, and also a preparation showing a number of small hydatids that were “coughed up from the lungs of a female.” There are also in this department (Dr. Acland’s) two examples of hydatids from the diaphragm, apparently belonging to two separate cases. One is described as a large “hydatid in the diaphragm covered by the pleura,” whilst the other is spoken of as “springing from the diaphragm and projecting into the sac of the pericardium.” There is likewise a preparation showing a number of small specimens of hydatids that were passed _per anum_ by a female. It is conjectured that they came from the liver.

The small pathological museum attached to the Brighton and Sussex Hospital is particularly rich in hydatids. Amongst others, it contains preparations illustrative of the remarkable case of hydatids in the region of the prostate, communicated by Mr Lowdell, in the ‘Lancet,’ in 1846.

The comparatively large museum adjoining the Norfolk and Norwich Hospital displays a choice series of hydatids, chiefly from the collection of the late Mr Crosse. That eminent surgeon prepared a special set of specimens to illustrate the process of natural cure by calcareous degeneration; and I may here, perhaps, be pardoned for mentioning that it was the study of these and other entozoa in Mr Crosse’s Collection, some thirty or more years ago, that first drew my attention to the phenomena of parasitic life. Illustrations of the helminths in question are still in my possession. In one case (which is instructive as indicating the possibility of death from the simplest form and commonest habitat of an hydatid) a lad, twelve years old, received a slight blow from a playmate. Something gave way, and death speedily followed. It was found by post-mortem examination that a solitary liver hydatid, rather larger than a cricket-ball, had been ruptured. Although the case is almost unique, it is nevertheless by no means pleasant to reflect upon the fact that under similar circumstances a slight blow might prove fatal to any one, no matter in what internal organ the bladder worm happened to be situated.

Before concluding my summary notice of the human hydatids contained in the metropolitan and certain other museums, there is an interesting literary contribution that I cannot pass unnoticed. In the November number of the ‘Indian Medical Gazette’ for 1870 an article occurs in which it is stated that the Calcutta Medical College Museum contains eighteen specimens of hydatid cysts of liver. This fact was, it seems, originally adduced to show, not the frequency, but rather the rarity, of the occurrence of hydatids in India. However, from a valuable communication by Dr James Cleghorn, which was published in the same periodical for the following March, it appears that hydatids of the liver are much more common in India than is generally supposed. This, he says, is owing to the circumstance that many of the so-called cases of tropical abscess are neither more nor less than examples of hydatid cysts that have suppurated. Besides Cleghorn’s evidence, we have the previous testimony of the Inspector General I. M. D., whose Report for 1868-69 I have already referred to in connection with _Cysticercus_ in beef. He says: “During some three months’ regular observation of the animals killed at the Commissariat slaughter-house here, at least 70 per cent. of the beef livers may be calculated as thus affected. Cobbold, writing of the _Tænia echinococcus_, says that ‘this little tapeworm infests only the dog and the wolf.’ Therefore, considering the immense number of pariah dogs fed on the refuse of animals infected with hydatids, it seems more than probable that the parasite must attain its strobila condition in their intestines, and through them be eventually disseminated over the pastures on which the cattle graze.”

I now turn to a neglected phase of the subject from which much practical instruction may be gathered. The consideration of the pathological phenomena of hydatid disease as it affects the lower animals is of high interest, and no prejudice should induce any medical man from accepting such useful data as may be gathered from this source. The facts of hydatid parasitism in animals, though often peculiar, are, for the most part, of an order similar to those presented in the human subject. If any medical practitioner thinks it beneath his dignity to study the pathology of the lower animals, the conduct of John Hunter in this respect is a standing protest against such narrowness.

The museum of the Royal College of Surgeons of England contains some of the finest specimens of hydatids from the lower animals that are to be seen anywhere, the very choicest of them having been selected by Hunter himself. That distinguished man sought information from every available source, and hydatids were for him of almost equal interest, whether found in the body of a human being or in the carcase of an ox or an ass. Now, at all events, neither pathologists nor sanitarians can well afford to neglect comparative pathology; and, for myself, I am free to say that the yearly exposition to the students of the Royal Veterinary College of the phenomena of parasitic life amongst animals has brought with it an ever-increasing knowledge of the most curious and often unlooked-for information. Some of the data thus supplied are quite remarkable. Let me also add that my studies of the entozoa of wild animals have put me in possession of particulars of high value in regard to the larger question of the origin of epidemics. Beasts, birds, reptiles and fishes, of every description, are liable to succumb to internal parasites, and there is practically no end to the variety of useful information to be obtained from this source. I have collected materials almost sufficient for a separate treatise on this department of the subject, but I fear I shall never have either the time or opportunity to give the facts due publicity. Here, for obvious reasons, I must for the most part restrict myself to the hydatids properly so called.

Referring, in the first instance, to the hydatids of animals that have the same mode of origin and exhibit the same general characteristics as those found in man, I notice that four of the metropolitan museums exhibit nine examples of liver Echinococci. The Hunterian Collection shows specimens of this kind from the pig, monkey, zebra, and lion. The museum at St Bartholomew’s Hospital contains two examples from the pig and one from a cow; whilst the animal liver-hydatids preserved in the King’s College and Guy’s Museums, respectively, are from the pig and sheep. That from the latter is partly calcified. Respecting animal hydatids affecting the lungs, the Cambridge Museum exhibits a simple acephalocyst from a monkey, and the Guy’s Hospital Museum shows a pulmonary hydatid from the kangaroo. In the museum at Oxford, Dr Acland’s (pathological) department shows a preparation of “one large echinococcus cyst from the abdomen of a baboon,” whilst Dr Rolleston’s department (anatomical) displays the echinococcus itself from the “cavity of the abdomen of the same animal.” The collection also contains a variety of other bladder worms from different animals. The Hunterian Museum, Lincoln’s Inn, exhibits four or five alleged examples of hydatids from the kidney of the sheep, besides another from the spleen. Some of these are of very doubtful character. A cystic kidney from the sheep, preserved in the London Hospital Museum, and originally supposed to have been due to hydatids, is (as hinted in the MS. catalogue) certainly not of parasitic origin. In regard to the occurrence of hydatids in the heart of animals the Hunterian series shows two good examples from cattle, whilst the collection at University College exhibits one taken from the wall of the left ventricle of a sow. This was presented by Dr Elliotson.

In the museum of the Royal Veterinary College there are a number of excellent preparations of true hydatids taken from various animals, especially from cattle, swine, and sheep; and there are also many kinds of bladder worms which, though often called “hydatid” by veterinarians, have a totally different origin from that of the true Echinococci. The so-called gid-hydatids (Cœnuri) and slender-necked hydatids (_Cysticercus tenuicollis_) are of this description. Specimens of the polycephalous brain hydatid, or Cœnurus, also exist in the museums connected with St Bartholomew’s, Guy’s, and St Thomas’s Hospital Medical Colleges, as well as in both the anatomical and pathological departments of the Oxford Museum. Specimens of large Cœnuri occurring in the soft parts of rabbits may be seen in the Guy’s Museum (presented by Mr Carpenter). Similar characteristic specimens exist in the Oxford Collection, labelled _C. cuniculi_, obtained from the “masseter and infraspinatus” muscles of a rabbit. My private collection also contains a recent addition of this remarkable hydatid, sent to me by Mr Alston from Ayrshire. It is the only one I have seen from Scotland. In the second half of this work these Cœnuri will again come under notice. Three examples of the slender-necked hydatid (from a monkey and two sheep respectively) may be seen in the Guy’s and University College Collections, and there are several in the museum of the Royal Veterinary College.

I cannot go out of my way to speak of other bladder worms, except so far as to call attention to the heart of a bear preserved in the museum at Guy’s, the walls of which are crowded with Cysticerci. That unique preparation ought to be carefully examined and described. The Hunterian Museum contains two magnificent specimens of hydatids affecting the bones of cattle. In the one case a solitary vesicle occupies the shaft of the humerus; whilst in the other several “acephalocysts” have taken up their residence within the cancellous structure of the ilium.

In the matter of human mortality from hydatids I have already supplied statistical evidence of the unenviable distinction which our Australian colonies exhibit, and in addition to the facts brought forward I may add that Dr Lewellin has mentioned to me a fatal case in which an hydatid occupied the whole length of the vertebral canal. The patient was under Dr Annand’s care. There could be no doubt as to the genuineness of the case, as the spinal cyst was tapped during life, when echinococcus hooklets were found.

Through Dr Lewellin I am also indebted to Dr H. B. Allen, pathologist at the Melbourne Hospital, for the particulars of a case of hydatids of the cerebrum, which are given as follows:

“J. Q--, aged 15, was admitted into the Melbourne Hospital on the 13th November, 1877, suffering from partial left hemiplegia. He rapidly became insensible and died next day. His mother furnished the following history.

“He had been woodcarting in the bush for a considerable time, and while thus engaged eight weeks before admission began to lose power in his left arm and leg; gradually the paralysis increased, and he was taken home, where he remained for six weeks. During this time he had every week an attack of severe headache, and once he lost all sight for over half an hour. Gradually the symptoms increased, and he was taken to the hospital, but even then was able to walk with assistance part of the way.

“At the autopsy, when the calvarium was removed, a large cyst about four inches in diameter was found on the mid-convexity of the right hemisphere of the cerebrum, slightly towards its anterior part. It formed a marked prominence on the anterior surface of the brain, and was bounded superficially by the pia mater and arachnoid, which were neither noticeably thickened nor adherent to the dura mater. On opening the cyst it was seen to extend inwards and abut on the wall of the lateral ventricle, and consisted of the ordinary gelatinous membrane, studded internally with little granular eminences, some pellucid, some opaque white. The contents were thin limpid fluid. The brain tissues around presented scarcely any induration. All other organs structurally healthy, congestion being the only morbid condition present.

“The specimen is preserved in the hospital museum, which contains two other preparations of hydatids in the brain, and also an hydatid cyst of large size growing from the interior of the frontal bone.”

In concluding this account of hydatids I may remark that, by the employment of sanitary measures, the disorder might, in course of time, be thoroughly stamped out. What these measures are I have already stated.

I need hardly say that the following bibliography by no means exhausts the records of echinococcus disease. In Dr Albert Neisser’s recent monograph nearly a thousand separate cases are quoted and classified. The monograph of Dr Hearn, which is not mentioned in Neisser’s work, also contains a valuable bibliography.

English literature. _Hydatids in general_ (BIBLIOGRAPHY No. 20 _a_). --_Ballard, E._ (review of Henoch), ‘Med.-Chir. Rev.,’ 1854.--_Bird, S. D._, ‘On Hydatids of the Lung; their diagnosis, prognosis, and treatment,’ 2nd edit., Melbourne, 1877.--_Busk_, “On the Nat. Hist. of the Echinococcus,” ‘Micr. Soc. Trans.,’ orig. series, vol. ii, 1849.--_Budd, G._, ‘Diseases of the Liver,’ Lond., 1845.--_Carmichael, R._ (lecture), ‘Dub. Med. Press,’ 1840, p. 91.--_Cobbold, T. S._, ‘Entozoa,’ chap. vii and viii, 1864.--_Idem_, “On Hydatid Disease” (lecture), ‘Lancet,’ June, 1875, p. 850.--_Idem_, “On Hydatid Diseases of Man and Animals” (museum specimens), in a series of articles contributed to ‘Brit. Med. Journ.,’ Oct., 1875, to Jan., 1876; fully reprinted in the ‘Veterinarian,’ Feb., 1876.--_Copland, J._ (Art. “Hydatids”) in his ‘Dictionary,’ 1848.--_Davies, T._, ‘Lond. Med. Gaz.,’ 1835.--_Gairdner, J._, and _Lee_, ‘Edinb. Med. and Surg. Journ.,’ 1844.--_Goodsir, H. S. D._ (same ref., Lee’s case), 1844.--_Goodsir, J._ (same ref.), 1844.--_Gross, S. D._, ‘Elements of Path. Anat.,’ chap. xv, Boston, U.S., 1839.--_Hawkins, C._, ‘Lancet,’ 1833.--_Hjaltelin_, ‘Edinb. Med. Journ.,’ 1867; see also Dobell’s ‘Report on the Progress of Practical and Scientific Medicine,’ London, 1870.--_Hodgkin, T._, in his ‘Lectures on the Serous and Mucous Membrane,’ 1838.--_Kerr, W._ (art. “Hydatids”) ‘Cyclop. of Pract. Med.,’ 1833.--_Leared, A._ (prevention), ‘Med. Times and Gaz.,’ 1863.--_MacGillivray, P. H._ (see below, miscell. cases).--_Murchison C._, in his ‘Clinical Lectures,’ Lond., 1868, p. 54; 2nd edit., 1877.--_Idem_, “Hydatid Tumours of the Liver; their danger, their diagnosis, and their treatment,” ‘Edinb. Med. Journ.,’ 1865.--_Nettleship, E._, “Notes on the Rearing of _Tænia echinococcus_ in the Dog from Hydatids, &c.,” ‘Proc. Royal Soc.,’ 1866, p. 224.--_Rose, C. B._, “On the Vesicular Entozoa, and particularly Hydatids,” ‘Lond. Med. Gaz.,’ 1833-4, p. 204.--_Stephens_, ‘Lancet,’ 1833; the ‘Veterinarian,’ 1831, p. 284.--_Thompson, T._ (remarks), ‘Lancet,’ 1851.--_Wilson, E._, “On the Structure, Classification, and Development of the _Echinococcus hominis_,” ‘Med.-Chir. Trans.,’ 1845.--_Yates, G._, “On Hydatid Disease,” ‘Assoc. Med. Journ.,’ vol. iii, 1855.

_Hydatids of the liver_ (BIBLIOGRAPHY No. 20 _b_).--_Abercrombie, T._, ‘Lond. Med. Journ.,’ vol. ii, p. 276, 1829.--_Alison, S. S._, ‘Lond. Med. Gaz.,’ 1844.--_Barclay_, ‘Brit. Med. Journ.,’ Nov., 1868, p. 494.--_Barker, T. A._ ‘Lancet,’ and ‘Path. Soc. Trans.’ 1855.--_Barlow_, ‘Lond. Med. Gaz.,’ 1857.--_Beith_, ‘Path. Soc. Trans.,’ 1852.--_Bradbury, J. B._ (six cases), ‘Brit. Med. Journ.,’ Oct., 1874, pp. 526-558.--_Idem_, ‘Brit. Med. Journ.,’ 1876, vol. ii, p. 646.--_Brinton_, ‘Lancet,’ 1854.--_Idem_, ‘Lancet,’ 1858.--_Bristowe, T. S._, ‘Path. Soc. Trans.,’ 1851.--_Idem_, ‘Path. Soc. Trans.,’ 1858.--_Broadbent, W. H._, “Hydatids of the Liver; Paracentesis followed by free Incision;” ‘British Med. Journ.,’ Nov. 30th, 1878.--_Brodie, B. C._ (supposed), ‘Lond. Med. Gaz.,’ 1828.--_Brook, C._, ‘Lancet.,’ Feb., 1868, p. 162.--_Buchanan_, ‘Surg. Med. Gaz.,’ 1861.--_Budd, W._, ‘Brit. Med. Journ.,’ 1859.--_Chambers, T. K._, ‘Lond. Med. Gaz.,’ 1846.--_Cox, T._, ‘Lancet,’ and ‘Med.-Chir. Trans.,’ 1838.--_Crosse, J. G._, ‘Lancet,’ 1837.--_Curling T. B._, ‘Med.-Chir. Trans.,’ 1840.--_Daly, O._ (supposed), ‘Brit. Med. Journ.,’ 1859.--_Davies H._, ‘Path. Soc. Trans.,’ 1848.--_Dickenson_, ‘Lond. Med. Gaz.,’ 1861; ‘Path. Soc. Trans.,’ 1862.--_Duncan, A._ (near the portal vein), ‘Edin. Med. and Surg. Journ.,’ 1808.--_Duncan, P. M._ (several cases), ‘Prov. Med. and Surg. Journ.,’ 1850-52.--_Elliotson, J._, ‘Lancet,’ 1832.--_Fearn, S. W._ (immense cyst), ‘Brit. Med. Journ.,’ Nov., 1868, p. 496.--_Fletcher, T. B. E._, ‘Prov. Med. and Surg. Journ.,’ 1846.--_Freer, W. G._, ‘Lancet,’ and ‘Prov. Med. and Surg. Journ.,’ 1845.--_Gaitskell, W._ (1000 discharged) ‘Lond. Med. Repository,’ 1815.--_Gulland_, ‘Edin. Med. Journ.,’ 1860.--_Harley, J._, ‘Lancet,’ May, 1866, p. 538, and ‘Med. Chir. Trans.,’ 1866.--_Idem_, in ‘St Thomas’s Hospital Reports,’ 1877, p. 291.--_Hastings, C._, ‘Brit. Med. Journ.,’ 1858.--_Heaton_, ‘Brit. Med. Journ.,’ Oct. 31st, 1874, p. 557.--_Heckford, N._, ‘Brit. Med. Journ.,’ Sept., 1868, p. 332.--_Hillier_, ‘Lancet,’ and ‘Path. Soc. Trans.,’ 1855.--_Hutchinson, J._, ‘Lancet,’ Oct., 1862.--_Inglis, A._, ‘Brit. Med. Journ.,’ 1859.--_Leared A._ (Hjaltelm’s case), ‘Path. Soc. Trans.,’ 1863.--_Logan_ (thousands present), ‘Path. Soc. Trans.,’ and ‘Med. Times and Gaz.,’ March, 1865, p. 243.--_Lyon, E._ (several cases), ‘Prov. Med. and Surg. Journ.,’ 1850.--_Murchison, C._ (rupture through pleura), ‘Path. Soc. Trans.,’ 1861.--_Idem_, ‘Lancet,’ July, p. 75, 1868.--_Page_, ‘Brit. Med. Journ.,’ and ‘Lancet,’ Nov., 1864.--_Pavy, F. W._ (expectorated), ‘Med. Gaz.,’ 1851.--_Idem_, ‘Med.-Chir. Trans.,’ and ‘Lancet,’ Sept., 1866, p. 234.--_Peacock_ (two cases, expectorated), ‘Lond. Med. Gaz.,’ and ‘Lancet,’ 1850.--_Pemberton, O. A._ (rupturing diaphragm), ‘Prov. Med. Journ.,’ 1848.--_Philipson_, ‘Brit. Med. Journ.,’ Oct. 31st, 1874, p. 557.--_Pollock, J._ (fatal), ‘Path. Soc. Trans.,’ 1854.--_Idem_ (opening into lung), ‘Lancet,’ Jan., 1865, p. 63.--_Rees, G. O._, ‘Guy’s Hosp. Rep.,’ 1848.--_Idem_ (lecture), ‘Lond. Med. Gaz.,’ 1849.--_Richards, C. C._, ‘Lancet,’ Jan., 1865, p. 261.--_Roberts_, ‘Lancet,’ 1833.--_Russell, J._, ‘Prov. Med. and Surg. Journ.,’ 1851.--_Sadler, M. T._ (Cæsarean section), ‘Med. Times and Gaz.,’ Aug., 1864, p. 141.--_Salter; H._, ‘Path. Soc. Trans.,’ 1860.--_Savory, W. S._ (letter), ‘Lancet,’ May, 1866, p. 410.--_Sherwin, H. C._ (fatal), ‘Edin. Med. and Surg. Journ.,’ 1823.--_Sibson, F._, ‘Lancet,’ July, 1868, p. 76.--_Sloane, J._ (puncture), ‘Brit. Med. Journ.,’ 1858.--_Thompson H._, ‘Path. Soc. Trans.,’ and ‘Lancet,’ 1858.--_Trimnell, G. C._, ‘Lond. Med. Repos.,’ 1821.--_Ward, S. H._, ‘Lancet,’ 1868, vol. ii, pp. 141, 305, and 474.--_Wearne, V._ (perforating diaphragm), ‘Brit. Med. Journ.,’ July, 1864, p. 31.--_Wilks_ (escaping by gall-ducts), ‘Path. Soc. Trans.,’ 1860.--_Young, J._, ‘Edin. Med. and Surg. Journ.,’ 1829.

_Hydatids of the liver and other organs together_ (BIBLIOGRAPHY No. 20 _c_).--_Beale, L._ (kidney), ‘Arch. of Med.,’ vol. i, p. 31, 1857; see also same case by _Bristowe_, ‘Path. Soc. Trans.,’ 1853.--_Billing_ (lungs), ‘Lond. M. and S. Journ.,’ 1831, p. 58.--_Griffith, J. W._ (abdomen), ‘Lond. Med. Gaz.,’ 1844.--_Heslop, T. P._ (kidney), ‘Month. Journ. of Med. Sci.,’ 1850.--_Richardson_ (kidney, Dr Mackinder’s case), ‘Lancet,’ 1855.

_Liver cases occurring in America_ (BIBLIOGRAPHY No. 20 _d_). --_Alexander, E._ (200 present), ‘Boston Med. and Surg. Journ.,’ 1838.--_Finnell_, ‘New York Med. Journ.,’ 1856, p. 216.--_Minot, T._ (expectorated), Bost. Soc. for Med. Improv., 1859, and ‘Brit. Med. and Surg. Journ.,’ 1860, p. 297.--_Webber, J. E._, ‘New York Med. Times,’ 1853, and ‘Bost. Med. and Surg. Journ.,’ 1853, p. 126.

_Hydatids of the lungs and pleura_ (BIBLIOGRAPHY No. 20 _e_). --Cholmeley, ‘Guy’s Hosp. Rep.,’ 1837.--_Dowling, F._, ‘Australian Med. Journ.,’ 1864.--_Duffin, A. B._, ‘Beale’s Archives,’ 1857, vol. i, p. 253.--_Hare,_ ‘Path. Soc. Trans.,’ 1857-8.--_Hill, J._, ‘Med. and Philos. Comm.,’ 1784, vol. ii, p. 303.--_Hutchinson, J._, ‘Path. Soc. Trans.,’ 1854.--_Kirkes, W. S._, ‘Med. Times and Gaz.,’ 1851.--_Leared, A._, ‘Path. Soc. Trans.,’ 1857.--_Peacock_, ‘Lancet,’ 1850.--_Ridge, J._, ‘Guy’s Hosp. Rep.,’ 1836, p. 507.--_Rigden, G._, ‘Prov. Med. and Surg. Journ.,’ 1852.--_Smith, F. G._, ‘North Amer. Med.-Chir. Rev.,’ 1858, p. 333.--_Todd, R. B._, ‘Med. Times and Gaz.,’ 1852.

_Hydatids of the Kidney_ (BIBLIOGRAPHY No. 20 _f_).--_Adams, A. L._, ‘Lancet,’ 1864, p. 375.--_Barker, T. H._, ‘Glasg. Med. Journ.,’ 1855-6, p. 439.--_Duncan_, ‘Liverpool Med. Journ.,’ 1834.--_Dunn, J._, ‘Lond. Med. Repos.,’ 1817.--_Fussell, E. F._, ‘Lancet,’ 1851.--_Lettsom_ (two cases), ‘Trans. Med. Soc. of Lond.,’ 1789, p. 33.--_Ward, W._, ‘Lancet,’ 1846.--_Wilson, J._ (lecture) ‘Lond. Med. Repos.,’ 1822.

_Hydatids of the spleen, omentum, and abdominal cavity_ (BIBLIOGRAPHY No. 20 _g_).--(Anonymous), ‘Edin. Med. and Surg. Journ.,’ 1819, p. 50.--_Bailey, F._, ‘Lond. Med. Repos.,’ 1826.--_Bright, R._ (remarks on cases) ‘Guy’s Hosp. Rep.,’ 1838.--_Bryant, T._ (simulating ovarian disease), ‘Guy’s Hosp. Rep.,’ 1868, p. 235.--_Budd, G._ (omentum), ‘Med. Times,’ 1838.--_Idem_ (rep. by Parsons), ‘Brit. Med. Journ.,’ 1859.--_Burman_, ‘Prov. Med. Journ.,’ 1847.--_Crowther, C._, ‘Edin. Med. and Surg. Journ.,’ 1826, p. 49.--_Greenhow, E. H._, ‘Lancet,’ 1862.--_Little, W. I._ (simulating ovarian disease), ‘Brit. Med. Journ.,’ 1857.--_Macleay, K._, ‘Edin. Med. and Surg. Journ.,’ 1806.--_Morley, J._ (partly pelvic), ‘Lancet,’ 1845.--_Newman, W._ (simulating ovarian disease), ‘Obstetr. Soc. Trans.,’ vol. iv, 1862.--_Obre_ (peritoneal), ‘Path. Soc. Trans.,’ 1854.--_Ogle, J._ (omentum), ‘Path. Soc. Trans.,’ 1860.--_Simpson, A. R._ (peritoneal), ‘Edin. Med. Journ.,’ 1861-62.--_Simpson, J. Y._, ‘Assoc. Med. Journ.,’ 1854, p. 137.--_Thompson, T._, ‘Lancet,’ 1843.--_Thompson, A. T._ (simulating ovarian disease), ‘Lancet,’ 1833.

_Hydatids within the pelvic cavity_ (BIBLIOGRAPHY No. 20 _h_). --_Birkett, J._ (voided), ‘Guy’s Hosp. Rep.,’ 1851, p. 300.--_Bryant, T._, ‘Lancet,’ 1865, pp. 566 and 589.--_Corrigan_ (ovarian), ‘Dub. Quart. Journ.,’ vol. i, 1846.--_Crampton_ (ovarian), ‘Dub. Quart. Journ.,’ vol. ii, 1846.--_Curling, T. B._ (bladder), ‘Med. Times and Gaz.,’ 1863.--_Farre, A._, ‘Lancet,’ 1862.--_Habershon_, ‘Path. Soc. Trans.,’ 1860.--_Hughes_, ‘Lond. Med. Gaz.,’ 1861.--_Hunter, T._, ‘Trans. of Soc. for Improv. of Med. and Chir. Knowledge,’ 1793, p. 34.--_Jennings_ (simulating pregnancy), ‘Dublin Quart. Journ.,’ 1855.--_Lowdell_, ‘Lancet,’ 1846.--_Maunder_, ‘Lancet,’ Sept., 1864, p. 351.--_Sadler, M. T._ (voided), ‘Med. Times and Gaz.’ 1865.--_Simon, J._ (voided), ‘Lancet,’ 1853.--_Wakley_, ‘Lancet,’ 1863.--_White_, ‘Med. Gaz.,’ 1842.

_Hydatids of the heart and blood-vessels_ (BIBLIOGRAPHY No. 20 _i_). --_Bigger_, ‘Dub. Path. Soc.’ Rep. in ‘Lancet,’ 1830.--_Budd, G._, ‘Path. Soc. Trans.,’ 1839.--_Coote, H._, ‘Lond. Med. Gaz.,’ 1854. --_Goodhart_, ‘Brit. Med. Journ.,’ Nov. 27, 1875.--_Price, D._, ‘Lond. Med. Repos.,’ 1822.--_Smith, R._, ‘Lancet,’ 1838.--_Trotter_, ‘Chem. and Med. Essays,’ 1736.--_Wilks_ (Henderson’s case), ‘Path. Soc. Trans.,’ 1860.

_Hydatids of the brain and cranial cavity_ (BIBLIOGRAPHY, No. 20 _k_). --(Anonymous) ‘Lancet,’ April, 1864, p. 444.--_Bailey, F._, ‘Lancet,’ 1825; ‘Lond. Med. Repos.,’ 1826.--_Barker, T. A._, ‘Path. Soc. Trans.,’ 1858.--_Bennett, J. R._, ‘Med. Times and Gaz.,’ Jan., 1862.--_Berncastle, J._, ‘Lancet,’ 1846.--_Bree, C. R._, ‘Lancet,’ 1837.--_Brittan, F._, ‘Brit. Med. Journ.,’ 1859.--_Burton_, ‘Med. Times and Gaz.,’ 1862.--_Dagleish, G._, ‘Lancet,’ 1832.--_Fletcher, T. B. E._, ‘Assoc. Med. Journ.,’ vol. iii, p. 161, 1855.--_Headington_, ‘Edin. Med. and Surg. Journ.,’ vol. xv, 1819, p. 504.--_Helsham_, ‘Med. Comment.,’ vol. xiii, 1788, p. 289.--_Macnamara, W. H._, ‘Brit. Med. Journ.,’ vol. ii, p. 616, 1876.--_Rigden, G._, ‘Prov. Med. and Surg. Journ.,’ 1852.--_Stewart, J._, ‘Lancet,’ 1848.--_Sturton_, ‘Lancet,’ 1840.--_Wilson, E._, ‘Lancet,’ 1848.

_Hydatids of the bones_ (BIBLIOGRAPHY No. 20 _l_).--_Cobbold, T. S._, “Notice of Specimens of Tibial Hydatids in Nottingham,” ‘Brit. Med. Journ.,’ 1865, and in the ‘Veterinarian,’ Feb., 1866.--_Idem_, “Notice of Specimens from the Tibia in the Mid. Hosp. Museum,” _ibid.--Cooper, A._, “Foster and Lucas’s case affecting the Tibia,” ‘Surg. Essays,’ Lond., 1818.--_Coulson, W._ (tibia), ‘Med.-Chir. Trans.,’ 1858; see also _Daubeny, H._, ‘Path. Soc. Trans.,’ 1858.--_Erichsen, J. E._, in his ‘Surgery,’ 4th edit., pp. 728, 823, and 948, Lond., 1864.--_Hunter, W._ (tibial, Mus. Spec. at Glasgow), quoted in ‘L’Expérience,’ 1838, p. 531.--_Keate, R._ (os frontis), ‘Med.-Chir. Trans.,’ 1819.--_Lambert, J._ (tibia), ‘Lancet,’ 1826.--_Thompson, H._ (Hearne’s tibial case), ‘Path. Soc. Trans.,’ 1859.--_Webster, F. W._ (tibia), ‘New Eng. Med. Journ. of Med. and Surg.,’ 1819.--_Wickham, W. J._ (tibia), ‘Lond. Med. and Phys. Journ.,’ 1827.

_Hydatids of the breast, muscles, and soft parts_ (BIBLIOGRAPHY No. 20 _m_).--_Adams, J._ (abdominal parietes), ‘Lancet,’ 1851.--(Anonymous), “Hyd. in the Eye of a Girl,” ‘Boston Med. and Surg. Journ.,’ 1849, p. 28.--_Baird, J._ (muscles), ‘Edin. Med. and Surg. Journ.,’ 1821.--_Birkett, J._ (mammary), ‘Lancet,’ March, 1867, p. 263.--_Brodie, B. C._ (near scapula), ‘Lancet,’ 1818.--_Bryant, T._ (thigh), ‘Path. Soc. Trans.,’ 1859.--_Idem_ (thigh), ‘Lancet,’ 1862.--_Idem_ (breast), ‘Path. Soc. Trans.,’ and ‘Lancet,’ Nov., 1865, p. 565.--_Cholmeley_ (from right side), ‘Lancet,’ 1826.--_Cooper, B. B._ (neck and breast, two cases), ‘Guy’s Hosp. Rep.’ 1851.--_Idem_, in Birkett’s work on the ‘Breast,’ p. 183; the ‘Institute,’ vol. i. p. 119, 1850.--_Dixon, J._ (neck), ‘Lancet,’ 1851.--_Henry, M._ (breast), ‘Lancet,’ Nov., 1861, p. 497.--_Hewndon, A._ (neck), by Tyson, in ‘Phil. Trans.,’ 1706-7, vol. xxv, p. 2344.--_Jones, S._ (subperitoneal), ‘Path. Soc. Trans.,’ 1854.--_Rankine, J._, “Supposed Hyd. in Synovial Sheaths,” ‘Edin. M. and S. Journ.,’ 1830.--_Sands_ (neck), ‘Amer. Med. Times,’ 1861, vol. ii, p. 376.--_White_ (breast and arm), ‘Lancet,’ 1839.

_Hydatids of uncertain seat, or miscellaneous cases and observations_ (BIBLIOGRAPHY No. 20 _n_).--_Barrett_, ‘Lond. Med. Gaz.,’ 1838.--_Durrant, C. M._ (Ipswich Hosp.), ‘Prov. Med. and Surg. Journ.,’ 1851.--_Fagge, H._, ‘Lancet,’ July, 1868, p. 76.--_Greenhow, J. M._ (intestinal), ‘Lancet,’ 1823.--_Howship, J._ (case, with speculative remarks), ‘Edin. M. and S. Journ.,’ 1835.--_MacGillivray, P. H._ (orbit, &c.), ‘Austral. Med. Journ.,’ Aug., 1865.--_Idem, ibid._, March, 1867.--_Idem_ (3rd series of cases), _ibid._, July, 1872.--_Idem_ (treatment with kamala), _ibid._, July, 1872.--_Markham, W. O._, “On the ‘son hydatique,’” ‘Assoc. Med. Journ.,’ 1856, p. 1072.--_Musgrave_ (letter to Sir H. Sloane), ‘Phil. Trans.,’ vol. xxiv, 1704-5.--_Phillips_, ‘Lancet,’ July, 1868, p. 77.--_Russell, J. J._, ‘Dub. Journ.,’ 1838.--_Salter, H._, ‘Path. Soc. Trans.,’ 1854.--_Ward, T. O._, ‘Lond. Med. Gaz.,’ 1837.

_Hydatids of animals (acephalocysts)_ (BIBLIOGRAPHY No. 20 _o_). --_Böllinger_ (see Bibl. No. 49).--_Cobbold_, ‘Manual,’ l. c. (Bibl. No. 2), 1874.--_Crisp, E._ (in a turkey and in hogs), ‘Path. Soc. Trans.,’ 1863.--_East, J._ (see Steel).--_Findeisen_, “Echin. in der Lunge,” ‘Repertorium für Thierheilkund.,’ 1875, s. 48.--_Gross, S. D._ (in swine), ‘Elements of Path. Anat.,’ 1845, p. 118.--_Hunter, J._, “A Cyst (hydatid) which was filled with water, formed in and filling up the Bone (humerus) of an Ox (from Hunterian MS.),” more fully described in the ‘Catalogue of the Mus. Lond. Coll. Surg.,’ “Path.,” vol. ii, prep. No. 864, p. 201, 1847.--_Idem_, “On Hydatids in Sheep” (supp. to Trans. of a Soc., l. c., _supra_), 1793.--_Hutchinson, J._, “Hydatid in the Eye of a Horse,” ‘Path. Soc. Trans.,’ and ‘Lancet,’ 1857.--_Huxley, T. H._, “On the Anatomy and Development of _Echinoc. veterinorum_ (from a Zebra),” ‘Proc. Zool. Soc.,’ 1852.--_Kirkman, J._, “Chronic Disease of the Bones of the Cranium of a Horse, associated with the existence of Hydatids within a Cyst at the inferior part of the Orbit,” the ‘Veterinarian,’ vol. xxxvi, p. 77, 1863.--_Lepper_, “Hydatids in the Kidney of a Lamb,” the ‘Veterinarian,’ 1863, p. 524.--_Martin, J._ (in the liver of a sow), ‘Vet. Assoc. Trans.,’ 1842-3, pp. 330 and 364.--_Moorcroft, W._ (in the brain of a cow), ‘Med. Facts and Observ.,’ vol. iii, 1792.--_Morgan, A._ (in the brain of a mare), the ‘Veterinarian,’ 1855, p. 396.--_Peech, S._ (in the muscles of a horse), the ‘Veterinarian,’ 1854, pp. 80 and 209.--_Siedamagrotzky_ (see Bibliog. No. 49).--_Simonds, J. B._, “Remarks on Mr. Scruby’s case of Hydatids in the Liver of a Sheep,” ‘Trans. of Vet. Assoc.,’ 1842-3, p. 331.--_Steel, J. H._ (in liver of a cow; Mr East’s case), the ‘Veterinarian,’ 1878, p. 441.--_Stoddart_ (in liver of a cow), the ‘Veterinarian,’ 1838, p. 637.--_Thudichum, J. L. W._ (in sheep), ‘Assoc. Med. Journ.,’ 1856, p. 195.--_Vincent, J. P._ (in horse, causing lameness), the ‘Veterinarian,’ 1848, p. 674.--_Walker, A._ (in the liver of a sow), ‘Vet. Record,’ 1846, p. 185.--_Woodger_ (in the brain of a horse), the ‘Veterinarian,’ 1863, p. 75.

_Foreign Literature. Human Hydatids_ (BIBLIOGRAPHY No. 20 _p_). --_Böcker_, ‘Zur statistik der Echinoc.,’ Berlin, 1868.--_Davaine, C._, ‘Traité’ (l. c., Bibl. No. 1), p. 350, 1860; 2nd edit. p. 369, 1877.--_Idem_, “Recherches sur les hydatides, les échinoc., &c.,” ‘Gaz. Méd. de Paris,’ 1855.--_Idem_, “Recherch. sur le frémissement hydatique,” ‘Gaz. Med.,’ 1862.--_Eschricht_, ‘Danske videnskab. selsk. forhandl.,’ 1853.--_Finsen_, ‘Ugeskrift for Läger,’ Bd. iii, 1867; see also ‘Brit. and For. Med.-Chir. Rev.,’ 1868, p. 324; also ‘Schmidt’s Jahrb. für Med.,’ 1867, s. 181.--_Guérault_, “Sur la maladie hydatique, &c.,” ‘Gaz. des Hôp.,’ 1857.--_Hearn, A. W._, ‘Kystes hydatiques du poumon et de la plèvre,’ Paris, 1875.--_Heller, A._, “Die Schmarotzer der Leber,” von Ziemssen’s ‘Handbuch d. Spec. Pathol. und Therapie,’ Bd. viii, s. 559.--_Krabbe, H._, “Maladie causée en Island par les Échinocoques,” in his ‘Recherches Helminthologiques,’ p. 41, Paris, 1866; ‘Helm. Undersøgelser,’ Copenhagen, 1865, p. 40.--_Idem_, “Die echinoc. der Islander,” ‘Archiv für Naturg.,’ 1865, and in ‘Den med. Skole i Reykjavik,’ 1868.--_Idem_ (see T. R. Jones, Bibl. No. 2).--_Leuckart, R._ (l. c., Bibl. No. 1), Bd. i, s. 335, 1863; Bd. ii, s. 859, 1876.--_Linder_, ‘Echinococcen der Leber,’ Leipsic, 1869.--_Naunyn_, ‘Archiv für Anat., Physiol.,’ &c., 1862-3.--_Neisser, A._, ‘Die echinococcen Krankheit.,’ Berlin, 1877.--_Rassmussen_, ‘Bidrag til Kundskab om Echinoc.,’ &c., 1865; see also ‘Brit. and For. Med.-Chir. Rev.,’ 1866, p. 285, and 1867, p. 424.--_Schmalfuss_, ‘Ueber Leberechinococcus,’ Breslau, 1868.--_Tommasi, T._, ‘Storia di un caso di Echinoc.,’ &c., in an appendix (Nota) to his edition of my ‘Lectures’ (Vermi, &c.), Milan, 1873, p. 153.

NOTE.--As Leuckart, Davaine, and especially Neisser offer exhaustive analyses of the French and German literature of human hydatids, I will only give the authors’ names attached to such additional foreign memoirs and cases as have been published in England. These are quoted in my ‘Introductory Treatise on the Entozoa.’ Full references will be found in the “Bibliography” of that work under the following heads:--_Andral_ (pulmonary veins), _Angeli_, _Auglagnier_ (bladder), _Baillarger_ (brain), _Boinet_ (liver), _Chaubasse_ (abdominal), _Cruveilhier_ (liver and spleen), _Dupuy_ (hydatids in animals), _Demarquay_ (liver), _Dupuytren_ (muscles and viscera, &c.), _Fouquier_ (lungs), _Gayet_ (liver), _Goyrand_ (liver), _Guérard_, _Guillot_, _Hedinger_ (brain), _Heintz_ (liver), _Held_ (thigh), _Heller_ (lip), _Klencke_ (blood, &c.), _Kuhn_, _Lafforgue_ (liver), _Legroux_, _Livois_, _Luschka_ (liver), _Martinet_ (brain, liver), _Maug_ (hand), _Meissner_, _Micheá_ (brain), _Moissenet_ (liver), _Montault_ (brain), _Morrisseau_, _Nicolai_ (liver), _Oerstelen_ (kidney), _Pohl_ (abdominal), _Quinquirez_ (bladder), _Récamier_ (abdominal), Richard (liver), Roget (lungs), Roux (pelvic), _Rüttel_ (brain), _Schleissner_, _Sichel_, _Sömmering_ (eye), _Skoda_, _Tomowitz_ (bladder), _Zeder_ (brain).

Additional references to the echinococcus disease as it occurs in animals will be found at the close of the section devoted to the parasites of Ruminants (Bibliography No. 49), and I shall recur to the subject of mortality from “worms” further on.