TREATMENT 41 



developed embryo miracidium are characteristic. In 

 examining the urine the mucus and eggs may only be 

 found in the urine squeezed out of the bladder after it 

 has been previously nearly emptied by micturition. It is 

 well to remember that the patient may also have a vesical 

 calculus. 



The presence of these eggs distinguishes this disease 

 from other forms of haematuria. 



Treatment. There is no method of destroying or 

 removing the worms, situated as they are in the blood- 

 vessels. In exceptional instances adult worms have 

 been found free in the intestines. These probably have 

 passed through the liver, and as long as they are alive and 

 sexually active eggs will be passed. Treatment, therefore, 

 can be only palliative. In severe cases rest in bed is 

 essential. 



Bland diuretics, especially those with a sedative effect 

 upon the mucous membrane of the bladder, are indi- 

 cated ; such as buchu, with alkaline carbonates, boracic 

 acid, or best of all urotropine, m 5-gr. doses twice 

 daily. Oil of male fern and other anthelmintics in 

 some cases appear to produce a temporary improvement. 

 Possibly they may limit the fecundity of the female and 

 fewer eggs will then be passed. Methylene blue has been 

 advocated by some, but is worse than useless, as it may 

 cause renal trouble. Salvarsan does not have any good 

 effect. In the rectal condition the bowels must be kept 

 loose, with mild, non-irritating aperients such as paraffin, 

 and every effort made to prevent pelvic congestion. The 

 papillomata, if they cause any trouble, may be removed : 

 sometimes the adult worms may be found inside them. 

 The patient must leave the endemic area if possible. 



Prognosis. The prognosis is good. The direct and 

 indirect mortality amongst Europeans removed from the 

 endemic area is less than i per cent., and the amount of 

 tuberculosis does not differ greatly from the average. 

 The disease may last for years, as the symptoms 

 usually diminish in severity and ultimately cease. Major 



