As a rule the cyst is situated in the substance of the kidney, though at times it is found insinuating itself between the capsule and the gland. The tumors are liable to certain accidents, such as rupture from the effects of muscular as well as outside pressure, and in this way a spontaneous cure may eventually be brought about. They often form adhesions to surrounding parts and so implicate organs other than those in which they may originate. Inflammation occasionally occurs within them, and suppuration may proceed to their spontaneous burst ing and the escape of their contents, either into a natural outlet as the urinary passage, or even into the intestines. They may degen erate, as Sir William Roberts has demonstrated, and be converted into cretaceous masses consisting of phosphate of lime, cholesterin plates, and fatty granules.
Surgically speaking, the treatment of these cysts relatively to the kidney consists, after medical measures have failed either to elimi nate or to poison the parasite, in first exploring them with an aspira tor needle and then proceeding to open them freely for the puipose of clearing out their contents and draining them. In the case of a
renal hyclatid this should be effected through the loin by such an in cision as is described in connection with nephrotomy, by means of which the cyst can be effectually opened, scraped, and drained. certain instances and to facilitate the last-named object the side of the opening in the cyst may be secured by suture to the correspond ing lips of the cutaneous incision. In the case of the kidney, as Dr. Gardner observes, there are instances in which it is necessary to select nephrectomy ; this conclusion, however, is not likely to be arrived at until the sac has been fully explored. Dr. Bond's mode of dealing with renal hydatids" is referred to by Dr. Gardner in his paper as being the ideal method, and is also commended because time is saved in the after-treatment; he thus illustrates it: