PARASITES IN THE KIDNEY. 47 



then of blood in the urine, the tuberculous character of which is in- 

 dicated by the coexistence of an enlargement of the testicle, so much 

 the more likely will it be that the kidney itself has become involved 

 in the disease. The diagnosis receives further confirmation if we are 

 able to feel an uneven tumor in the region of the kidney, through the 

 flaccid walls of the abdomen. 



CHAPTER XI. 



PAEASITES IN THE KIDNEY. 



THE echinococcus is the parasite most frequently found in the kid- 

 ney, although even there it is met with less frequently than in the liver. 

 Its presence in this organ is originally due to the existence of the 

 embryo of the tenia echinococcus in the intestinal canal (see Vol. L). 

 We have no knowledge as to why the young brood, in their emigra- 

 tion from the bowel irito the other organs of the body, should some- 

 times enter the kidney. The echinococcus sacs, which occasionally 

 attain the size of a fist or of a child's head, are quite like those found 

 in the liver and spleen. They are embedded in a fibrous capsule be- 

 longing to the kidney. They may atrophy and burst, discharging their 

 contents in different directions. They may also occasion inflammation 

 and suppuration in the parts about them, and the renal abscess thus re- 

 sulting may burst into the peritonaeum, intestine, or pelvis of the kidney. 



The development of echinococci in the kidney may be entirely un- 

 attended by symptoms. In some instances, however, the patients com- 

 plain of a dull pain in the lumbar region, which we cannot well account 

 for. A tolerably sure diagnosis may be made out if we can feel an 

 irregular nodular tumor in the region of the kidney, and at the same 

 time can exclude carcinoma, tuberculosis, and hydronephrosis, to be 

 treated of hereafter. Certainty is only possible when cysts of the 

 echinococci or traces of them are discharged with the urine. The 

 hyaline walls of the daughter cysts, consisting of concentric layers, 

 distinctly recognizable under the microscope, are not easily mistaken. 

 Symptoms of renal colic may arise during their passage through the 

 ureters, and their discharge from the bladder is often attended by the 

 utmost distress, especially in men. 



[The strongylus gigas is the largest of known round worms. The 

 female may attain the length of half a yard or more. Its mouth is 

 bordered by six wart-like projections. The male is smaller, and at 

 his tail-end has a cup-shaped appendix, at the bottom of which is 

 the genital opening with the penis protruding from it like a hair. 

 The method of development of this parasite has not been ascertained. 



