with prostatic disease, care must be exercised in each particular case to separate the special factors to which the various symptoms are attributable. Thus in chyluria concurring with schistosomum disease there will be chyle in the urine in addition to blood. In such a combination the clot which forms will be large, will contain oil granules and globules and, very probably, microfilariæ, in addition to schistosomum ova; moreover, the microfilariæ will generally be detectable in the finger blood if looked for at night. Stone in the bladder, when suspected, has to be searched for with the sound. In gonorrhceal cystitis the history of gonorrhœa will be forthcoming. In prostatic disease enlargement of this organ may be made out. Difficulty may sometimes arise when ova are few in number, or when they have ceased altogether to come away in consequence of the death of the parent worms. The mischief wrought by the parasite remains, although the ova the most certain evidence of the parasite's previous presence may be discharged no longer. But, even if ova are very few, they may still be found in the last drop or two of urine passed. If they are no longer to be found in the urine, sometimes, by scratching the surface of the bladder with a sound and examining the shreds of mucus so obtained, a few— calcified, it may be, but presenting the characteristic spine may be seen with the microscope.
In rectal disease, if schistosomum be suspected, the mucus and fæces, or failing these one of the adenomatous growths, after removal by finger or forceps, should be examined for ova.
Prognosis.— An important element to be considered in venturing on a prognosis is the long life of the parasite. Sonsino mentions a case in which living ova were still being passed nine years after their first appearance, and after all chance of reinfection had ceased. Another important element in prognosis is the degree of infection; the greater the number of worms the more severe and the more extensive the disease they produce. As with filarial infection, the greater the number of cases in a district the greater
