I930 



DISEASES OF THE URINARY ORGANS 



as has already been mentioned, is an important factor in increasing 

 the sufferings of the patient, but its symptoms may be masked by 

 those of the disease. Urinary fistulae has already been referred to, 

 and cancer may also occur as a complication of the disease, but is 

 said to be rare. Ankylostomiasis and pellagra and other diseases 

 may also complicate a case. 



Diagnosis. — The only certain diagnosis is by the discovery of the 

 ova, but hsematuria in the endemic area must always be regarded 

 with suspicion. Centrifugalization is necessary when the ova are 

 in small numbers. 



Fairley recommends a complement fixation-test with an antigen prepared 

 from livers of infected snails. 



Prognosis. — The prognosis depends largely upon the possibilities 

 of infection, and is therefore better if removal from the infected 

 area is possible; for, according to Sandwith. 

 ' r most cases cease to pass eggs within three 



years of leaving that area. 



Treatment. — McDonagh and Christopher son 

 have recommended the intravenous injection 

 of tartar emetic, which should be administered 

 in the same way as for intestinal schisto- 

 somiasis (p. 1869) . Various treatments, such as 

 injections of sulphuretted hydrogen and carbon 

 dioxide gases into the bladder, have been 

 suggested. The drug commonly used in the 

 past was liquid extract of male fern, in 5-minim 

 doses, three times a day, continued for a long 

 time. It is said to reduce the haematuria and 

 lessen the discharge of eggs . Emetine has been 

 recommended hy several observers. Madden 

 recommends the washing out of the bladder 

 with injections of silver nitrate, beginning 

 with I in 10,000, and increasing the strength 

 gradually; orquininein a 4 per cent, solution; 

 or adrenalin in normal saline solution. 



In addition, boracic acid, in 5-grain doses, 

 three times a day, or helmitol, in 15 -grain doses, three times a 

 day, urotropine, salol, benzoic acid may be given, or the ordinary 

 buchu and hyoscyamus mixture may be administered. Large 

 quantities of water or Vichy water should be drunk to wash out the 

 urinary passages. 



If a calculus is present, it must be removed by lithotrity or by 

 perineal, not suprapubic, cystotomy. Cock's operation of cys- 

 totomy and drainage of the bladder gives relief in the later stages, 

 but Madden says that this only lasts for a few days, and then usually 

 diarrhoea and septic infection set in, and the patient dies in about 

 two weeks. 



With regard to fistulae, they ought to be thoroughly dissected out 

 and this may mean a very prolonged operation if it is to do any good. 



Fig. 778D. — Egg oi- 

 Schistosoma hcB- 

 matobium in Urine. 



(Photomicrograph.) 



