642 THI<: ANIMAL PARASITES OF MAX 



amount of leucocytosis (Balfour, 1 Douglas and Hardy 2 ). The 

 severe forms occur almost exclusively in men ; symptoms of catarrh 

 of the bladder make their appearance, vesical calculi are frequently 

 found, whilst the formation of stone in the kidneys and ureters is 

 rare. Urethral fistula occurs in bilharziasis, often without stricture, 

 and if granulations occur the fistula is distal to them. Goebel 3 

 regards the bilharzia fistula as a chronic burrowing of pus, caused by 

 the irritation set up by the ova as foreign bodies and consecutive 

 restricted suppuration ; and secondly as due to the passage of urine 

 through the defect in the epithelium or the wall of the urethra. The 

 fistulae, which are generally situated at the neck of the bladder and at 

 the membranous portion, are very tortuous and frequently very 

 numerous; they often lie embedded in well-marked tumours in fact, 

 in granulation tumours with marked inclination to excessive formation 

 of cicatricial tissue. The opening generally is in the perineal and 

 scrotal regions. In the case of a patient, aged 21, from the Transvaal, 

 Kutner 4 found by cystoscopic examinations the whole summit and 

 walls of the bladder covered with large and small tumours. In 

 addition to smooth glistening tumours, others were more or less dis- 

 integrated, and scattered large and small cauliflower-like growths 

 occurred. Like malignant growths, the tumours were inclined to 

 break down, the process extending from within outwards towards the 

 surface. Whether the hydrocele so frequent in Egypt has any 

 connection with bilharzia is not known. A frequent sequela of 

 bilharziasis is complete sexual impotence (Petrie 5 ). 



Bilharziasis of the rectum is manifested by symptoms of 

 dysentery; the repeated violent attempts at defalcation lead in time to 

 prolapse of the rectum, which sooner or later induces septic infection 

 and so death. In the mucosa of the rectum, polypoid growths similar 

 to those in the bladder are met with, due to the ova of the parasites 

 in the mucosa and submucosa. In the case of a man, aged 36, who 

 had lived for a long time in South Africa, Burfield 6 found in the 

 excised vermiform appendix ova of Schistosoma hcematobium ; he 

 assumed this to be a gradual secondary infection of the appendix, 

 whilst Kelly 7 mentions a case of primary bilharziasis of the appendix; 

 the eggs lay in the submucosa directly above the muscularis. 

 Tumours containing numerous ova are frequently found in the region 

 of the genitalia, thighs and scrotum. In one case Symmers 8 found 

 numerous male schistosomes in the portal blood and a copulating 



1 Balfour, Lancet, December, 1903. 2 Douglas and Hardy, ibid., October, 1903. 



3 Goebel, Centralbl. f. d. Krankh. d. Harn u. Sexualorgane, xvii. 



4 Kutner, ibid., xvi. 



5 Petrie, Brit. Med. fount., July, 1903. 6 Burfield, Lancet, February 10, 1906. 

 ' Kelly, quoted by Burfield. H Symmers, Lancet, January 7, 1905. 



