In the urine of women we find spermatozoa after coition a fact which may have great medico-legal importance.

8. Cancer Elements.

Two different forms of cancer elements are observed, though quite seldom: a. Isolated cancer-cells; b. Pieces of cancer-tissue.

a. The cancer-cells are variously (Pl. VIII., B, 1) and often quite oddly formed. They are large and for the most part caudate cells, with a very large and often more than one nucleus. Sometimes we observe the socalled vacuoles. Care must be taken not to regard the caudate cells of epithelium which come from the kidneypelvis as cancer-cells. The cancer-cells correspond to the epithelial covering of a cancerous growth, and generally arise in the bladder. Only from an abundant appearance of these peculiar and many-formed cells can we with certainty recognize a malignant growth.

b. Fragments of villous cancer (Pl. VIII., B, 2) may occur in various forms in the urine sediment. We either find the same well preserved, when we are able to distinguish the papillary growth under the microscope (it seldom appears in this condition), or on the other hand it may be necrotic, when the diagnosis is attended with considerable difficulty. The well-preserved cancerous tissue, under a magnifying power of 300 diameters, exhibits in its finest branches a characteristic treelike formation, similar to fringe, which consists of a widened blood-vessel (Hohlkolben) covered with a

single layer of epithelium. It is seldom that such a beautifully formed tree can be seen under the microscope. Usually sloughed off and much altered pieces of tissue only appear in the sediment, and the identification of these is very difficult. In the tree form the epithelium has generally undergone molecular disintegration, and is accompanied with bacteria; the villus itself is infiltrated with pus-corpuscles. In this molecular detritus, chiefly consisting of small flakes, we occasionally find forms which materially assist the diagnosis of villous tumor.

Often, if we treat the necrotic cancerous tissue with glycerine, and sometimes when we have not done this, we observe beautiful crystals of hæmatoidine. They appear of a brown-yellow color, either in beautifully built small rhomboids or in small, yellow, grassy tufts. Such cancerous tissues, treated with fuming nitric acid under the microscope, show by the well-known rainbow play of colors the reaction of the biliary coloring matters. Hæmatoidine is recognized in old blood-extravasations, but in the urinary sediment it is never observed except as isolated crystals. If, however, we find these crystals imbedded in necrotic tissue, then is the diagno sis of old hæmorrhagic and necrotic tissue assured. This condition has up to this time been found only with villous tumors. Hæmatoidine villus occurs only in acid urine.

There is yet another sort of crystal which has also been observed by us only in necrotic villous tissue, which appears only in acid urine, and may also serve as

an index for the diagnosis. These are small, colorless, crossed, aggregated leafy crystals, in dumb-bell form, which sometimes take on a spherical shape. These are a very rare form of calcium oxalate.

Sometimes with a low magnifying power (120) we observe thicker and darker-colored, tube-shaped, branching forms in necrotic flakes. These are small vessels which are to be seen in necrotic tissue.

If the urine is strongly alkaline, we find the villous tissue so changed and incrusted with phosphates, that a diagnosis of it can scarcely be made. One investigation of the urine in these cases is hardly sufficient for a diagnosis.

9. Entozoa.

We have not up to this time had an opportunity of observing entozoa, or even fragments of them, in the urine. According to the claims of other authors, the hooks of echinococci occur. We have, however, observed single hooks, as also a fragment of the sac of the echinococcus with the adhering animal forms, in the aspirated fluid of a kidney-tumor (Pl. VIII., A, 4); and it is possible that by rupture of the same into the pelvis of the kidney the hooks might appear in the evacuated urine.

In the tropics hæmaturia caused by entozoa is observed. Under this head the most important form of entozoa is the Distoma hæmatobium or Bilharzia hæma tobia. It penetrates most probably from the intestinal tract into the plexus venosus prostaticus, and there lays its eggs. These have an oval form, and on one end is

to be seen a short point. They stop up the small vessels of the mucous membrane of the bladder; then there arises a bladder-catarrh with hemorrhage, and the eggs become excreted in the urine. In the urinary sediment we find small flakes in such cases, in which under the microscope, besides numerous. blood- and puscorpuscles, are imbedded a great number of the eggs of Bilharzia hæmatobia.*

The male

[The adult parasite is a trematode. rarely exceeds one third of an inch in length, and is shorter and broader than the female, which is more filiform, and may attain to the length of three quarters of an inch. They bear two suckers, and the male a long canal in its upper half, in which the female is partially inserted during copulation. The ova are about 2 inch long and inch broad, and are characterized by a spine at the anterior part of the capsule. It is by the appearance of these in the urine that the cause of the hæmorrhage is to be diagnosticated. The cases in which it occurs in America seem to have contracted the disease in Afri ca. Belfield + records such a case.

The Strongylus gigas, a nematode worm found in the kidney-pelvis of dogs, wolves, horses, oxen, and some other animals, has been very rarely found in the human kidney. kidney. It resembles the ascaris lumbricoides, but has six instead of three papillæ

*We have to thank Dr. Sachs, of Cairo, for some very beautiful preparations of the natural sediment of endemic hæmaturia.

["Diseases of the Urinary Organs," p. 154.]

around the mouth, and is larger, the male reaching a foot in length and one quarter of an inch in breadth, and the female a yard in length. It may occur in the urine through its ova, or in adult form; probably, however, some recorded cases of the latter occurrence were really due to the presence of ascaris which had penetrated the renal passages from the intestine. When the parasite is present in the renal passages it may give rise to colic hæmaturia and pyuria.

The Pentastoma denticulatum, found under the capsule of the liver of herbivorous animals and man, was once found by Wagner under the capsule of the right kidney of a man dead from Bright's disease. Inasmuch as it has never been found in the urine in any form, it does not deserve further mention in this treatise.

The Filaria sanguinis hominis seu Bancrofti, as the probable cause of tropical chyluria and sometimes hæmaturia, is a matter of interest to American and English physicians, since several cases of its importation from the tropics have been brought to notice. The form usually seen is the embryonic. The embryos are long, snake-like, transparent, and apparently structureless, from to inch in length, and 3 inch in breadth. It is slightly tapering at the anterior extremity, and terminates at the end in a filamentous projection like the lash of a whip. Viewed through a magnifying power of six hundred diameters, transverse markings may be observed, but