5 YMPTOMA TOLOG Y 



1929 



lomata. Calculi may also form in the bladder, and interstitial 

 nephritis in the kidney. 



As the bladder becomes infiltrated it rises in the abdomen, and 

 may be felt above the pubes, and in this situation infection may 

 spread to the abdominal wall. In this case the typical bilharzial 

 tissue forms in the subcutaneous tissue, and, working its way to 

 the surface, forms a sinus lined with bilharzial granulations con- 

 taining eggs and discharging pus. These sinuses may spread, and 

 a large area of skin become involved. 



Bilharzial tissue may also form in the prostate and urethra. 



Symptomatology. — -The incubation is not known, but, according 

 to Sandwith, it varies from three to six months. At first no symp- 

 toms are exhibited, but in course of time frequency of micturition, 

 with a sensation of burning in the perineum or along the urethra, 

 may be noted, while there is some straining after passing urine. In 

 due course hsematuria appears, beginning with a few drops of blood 

 either at the end of micturition or after the urine has been passed. 

 Usually there are no symptoms with this hsematuria, but there may 

 be scalding. The urine is clear and acid, but some mucus may be 

 passed, which, if centrifugalized or allowed to settle, shows the 

 typical ova and, of course, red cells, leucocytes, and epithelial cells. 

 Usually the general health is good, but pains in various directions 

 may be felt — e.g., in the back, the perineum, the gluteal region, or 

 down the legs. 



Sooner or later the urine begins to stagnate in the hollows in 

 the mucosa formed by ulcers and by papillomata. When this 

 happens, the urine becomes alkaline and turbid, containing pus and 

 phosphates, as well as decomposing blood and ova. With this 

 decomposition of the urine cystitis appears, and the sufferings of 

 the patient begin in earnest, with at first increased, and later almost 

 constant micturition, scalding pains in the perineum and the 

 scrotum, together with tenesmus, which increase until he can rest 

 neither day nor night. In order to add, if possible, to his miseries, 

 the prostate may enlarge or a stone may form in the bladder, which 

 may be composed of uric acid or oxalates covered with phosphates, 

 or simply of phosphates. If the bladder is examined in this stage 

 it will be found to be thickened, and may be felt above the pubes. 

 Fistulae may form in the abdominal wall above the pubes, or the 

 urethra may be attacked. The urethral symptoms begin with 

 localized pain and the formation of a lump which develops an 

 abscess, and later urinary fistulae. 



The patient now becomes weak and anaemic, and begins to suffer 

 from pyonephrosis. The enlarged kidneys, and at times even the 

 ureters, may be felt through the abdominal wall. In course of time 

 septicaemia sets in, and the patient dies. On the other hand, cases 

 which have left the endemic area may slowly recover, the ova ceasing 

 to be passed. 



Complications. — Retention of urine from blocking of the urethral 

 opening by papillomata or a stone may occur. Stone in the bladder. 



