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.