DISTOMUM HyEMATOBIUM. 283 



Alterations of the bladder by the presence of this worm. The 

 lowest degree of the disorder in the mucous membrane of the 

 bladder is presented by the more or less circumscribed spots, 

 upon which is observed strong hypersemia, much bloody ex- 

 travasation, swelling and inflation of the mucous membrane, or 

 tenacious mucous, grayish-yellow masses of exudation in which 

 the eggs are imbedded. There are generally only small spots 

 varying in size from a lentil to that of a shilling, especially on the 

 hinder wall of the bladder. It is rare that the whole inner 

 wall of the bladder is injected and ecchymosed. The urine is 

 mucous, but pale and clear, and Bilharz found eggs in the urine 

 passed. In subsequent stages grayish-yellow, yellowish, dis- 

 coloured elevations, mixed with many pigment spots, are found, 

 covered with a very smooth, tenacious raucous membrane, as if it 

 had been kept in spirits. These elevations frequently form a 

 soft coat, sometimes a line in thickness, mixed with bloody 

 extravasations, and peeling off in small fragments at the surface, 

 which is so firmly attached to the mucous membrane, that, in de- 

 taching the former, the uppermost layer of the latteris separated 

 with it. Sometimes the calcareous incrustations of the egg- 

 shells, the deposition of the salts of the urine, and the aggre- 

 gations of eggs give the whole a sandy texture. Very rarely this 

 coat covers true ulcers with loss of substance. Frequently nothing 

 is to be seen but dingy red, gray, or black, somewhat elevated 

 pigment spots, together with fresh injection and apoplexy of the 

 healthy mucous membrane. 



All this is the consequence of the Distoma getting into the 

 smaller vessels, arid laying their eggs, which at last escape from the 

 ruptured vessels in these situations. My friend Reinhard, of 

 Bautzen (to whom I had transmitted a portion of the bladder 

 of the negro boy referred to by Griesinger and Bilharz, and 

 which Professor Griesinger kindly handed over to me), saw, 

 hanging out of a vessel accidentally opened by me, one of 

 these Distoma, which bore his female within him, but in other 

 respects allowed nothing more to be detected. 



At other times we find, on the mucous membrane of the bladder, 

 single or aggregated excrescences or vegetations, varying from the 

 size of a pea to that of a bean, and of a yellowish colour, or ecchy- 

 mosed with blood. They are 1 3 X// in height, verrucose, fungous, 

 cleft into separate points above, like cockVcomb or raspberry-like 

 condyloma, and narrowed or pedunculate at the base. They are 



