SUPPLEMENT 643 



pair in the left lung. Though schistosome eggs have been found by 

 some observers in the lung tissue, this is nevertheless the first case in 

 which living parasites have been found in the lesser circulation. 

 Perhaps they got there by way of the external iliac vein from the 

 veins of the bladder and rectum. 



In the female sex bilharziasis is incomparably rarer than in the 

 male and is generally limited to haematuria. Bilharziasis of the 

 vagina, which takes the form of an acute vaginitis, is frequent 

 according to Milton. 1 Horwood 2 found in one case a polypoid 

 tumour of the cervix uteri, and in the connective tissue of the tumour 

 Schistosoma ova, both in masses and singly, It could not be 

 established whether the ova reached the vagina and thence the cervix 

 directly, or through the urine from the bladder. 



The course of the disease is chronic, and in slight cases, provided 

 fresh infections clo not occur, is not unfavourable; in severe cases 

 the cachexia caused by loss of blood, or intercurrent diseases to 

 which the patients easily succumb e.g., pyelitis, pyelonephritis, 

 pyaemia, or uraemia lead to a fatal issue. 



In regions in which Schistosoma Juvniatobiuui is endemic, or in 

 patients from such regions, the diagnosis is easy by microscopically 

 finding the eggs in the urine. 



As regards the treatment of the affection this much must be said, 

 that so far there is in existence no certain remedy. In countries 

 where bilharziasis is endemic copaiva balsam is considered a specific. 

 Kutner (loc. cit.\ however, in the case of his patient who for a long 

 time had taken no inconsiderable amounts of copaiva, had no success 

 worth, speaking of to record. Urotropin (three times daily, i grm.) 

 has similarly failed, salol (075 grm. several times daily) perhaps affords 

 relief in affection of the bladder (Milton). Methylene blue, oil of 

 turpentine with extract of male fern (Brock 3 ), or the latter alone and 

 santonin given in small doses for a week at a time, in the morning, are 

 said by Petrie 4 to be of value. Sand with 5 and Harley 6 were not 

 very successful. By way of experiment Kutner for some time used 

 collargol per rectum, proceeding on the assumption that this prepara- 

 tion, which has proved of such remarkable service in bacterial infec- 

 tion, would perhaps render a continuance of life difficult for the 

 bilharzia worms. But this hope proved illusory. In order so far 

 as possible to limit the loss of blood, Kutner regularly employed 

 stypticin for long periods (three times daily, two tabloids of o-oi grm.) 



Milton, quoted by Looss, " Handb. d. Tropenkrankh.," v. Mense, 1905, i, p. 95. 



2 Horwood, Brit. Med. Journ., March 10, 1906. 



3 Brock, Journ. of Path, and Bact., 1893. 4 p etrie, loc. cit. 



5 Sandwiih, Annal. of Surgery, 1504, xxxix. e Harley, Lancet, 1870. 



