very much according to the degree and the duration of the infection. In almost every case of the Egyptian type of the disease the walls of the urinary bladder are early affected. All that may be apparent to the naked eye at this stage is a certain amount of injection of the small vessels of the mucosa vesicæ, and, according to Sonsino, certain exceedingly minute vesicular or papular elevations of the surface of this membrane. When these minute elevations are examined microscopically they are found to contain ova. Ova are also to be found in the dilated minute blood-vessels. Later, especially in the trigone of the bladder, there are found rounded patches of inflammatory thickening which project somewhat, are granular on the surface, and dense in consistence; on section they creak under the knife as if they contained gritty particles. It is evident that these elevated^ thickened patches are the result of an inflammatory, process provoked by the clusters of ova which the microscope reveals scattered throughout their entire extent. The ova are principally deposited in the submucosa, less extensively in the mucous membrane itself, still less abundantly in the muscular walls of the organ or in its subserous connective tissue. They tend to occur in groups, each of which is invested with a sort of connective-tissue capsule; or they may be lying in small blood-vessels which they occlude. Some ova are seen to have undergone calcification; others are still fresh, either segmenting, or already containing a miracidium. On the surface of the rounded patches already mentioned phosphatic deposits, also containing ova, are not uncommon; and sometimes the patches present minute sloughs. Besides these indurated patches, various forms of polypoid excrescence sometimes ulcerated may protrude from the mucous surface into the cavity of the bladder. These various hyperplasiæ frequently contain the adult parasite as well as ova.
In addition to what may be designated the specific changes in the mucosa, the muscular coats of the bladder are generally hypertrophied. In consequence of this, as well as of the ingrowth of villosities
