

ENDEMIC H^DMATURIA 39 



haemorrhage and (2) cystitis. The two conditions are 

 associated in varying degrees. The haemorrhage may be 

 profuse, and the resulting condition is the so-called 

 endemic hcematuria. Haemorrhage may be constant but 

 varying in amount, but more commonly is only met with 

 whilst the patient is at work, and sometimes occurs only 

 after violent exertion. It may be intermittent and not 

 occur for prolonged periods. 



The cystitis is also variable and sometimes intermittent, 

 but is not as a rule of the same severity as the cystitis that 

 results from a bacterial invasion, nor is it associated with 

 decomposition of the urine. This condition may be 

 superadded. Usually there is a discharge of mucus, 

 with or without blood. In the milder cases- this is not 

 in large amount, and the urine passed naturally may be 

 quite clear and free from mucus. If, after the urine has 

 been so passed the patient strains forcibly, in the few 

 drops that will now exude mucus may be found abun- 

 dantly. In this mucus the eggs with the terminal spine 

 will be found readily. 



Complications. Sometimes a large vessel may be opened 

 and severe haemorrhage occur, so that the bladder may be 

 filled with blood, which then clots. This blood-clot may 

 be broken up with a catheter, and can then be washed 

 out of the bladder. In rare cases perineal section may 

 be required. Cirrhosis of the kidneys may be a late 

 result and attended by high blood-pressure, cardiac 

 hypertrophy and all the symptoms of interstitial nephritis. 



Formation of Calculus. The frequency of bilharzia in 

 Egypt is usually considered to afford an explanation of 

 the frequency of vesical calculus in that country. The 

 eggs may be found in such calculi. On the other hand, 

 bilharzia disease is very common throughout Tropical 

 Central Africa and in South Africa, where vesical calculus 

 is almost unknown and must be rare. S. hcematobium t 

 therefore, cannot be considered as the only cause of the 

 prevalence of vesical calculi in Egypt. Fistula, which 

 in Egypt is said to be a frequent result, does not occur 

 elsewhere. 





