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Bilharziosis in South Africa 
Source of Infection. 
That the disease is conveyed by some means from infected water 
there is no doubt, but except that the miracidium is killed by minute 
traces of hydrochloric acid not a single experimental fact has yet been 
brought to light indicating the actual source and mode of infection. 
The old idea in Cape Colony, still adhered to curiously by some, was 
that the organism in some form crept up the urethra while the persons 
were bathing. For this reason some of the inhabitants of Cape Colony 
used to tie their genital organs up in a handkerchief before going into 
a river to bathe. This custom may have induced some writers erro¬ 
neously to try and prove that the prepuce cover worn by certain South 
African tribes was originally adopted as a protection against the parasite. 
That infection occurs in some manner while bathing I think there 
can be little doubt. Dr Darley Hartley, when practising in East 
London and Cathcart, saw many cases of Bilharziosis. They always 
occurred in boys or young adults, and he tells me that in almost every 
case he obtained a history of them having bathed in the Buffalo River. 
Dr Brock (1893, Journ. Pathol, and Bacteriol. vol. II. p. 52), 
relates an exactly similar experience when he lived in the Rustenburg 
district (Transvaal). Dr J. Allen (1888, Practitioner , vol. XI. p. 310) 
at one time Medical Officer for the Corporation of Maritzburg (Natal), 
writes as follows: “Nearly all the youths bathing in the Umzimdusi 
and Dorp Spruit are infected, while the girls, who do not bathe, remain 
free of the disease.” In the two outbreaks among English troops in the 
Transvaal, the men infected had been bathing in spruits or rivers. The 
only case of a European girl becoming infected, that I can find notes 
of, is one reported by Dr C. P. Childe (ill. 1899, Brit. Med. Journ. 
p. 644), and this girl, it was found on enquiry, had been in the habit of 
bathing in a freshwater pool on a farm in Natal. The facts seem to 
support the theory that infection occurs through the skin, for if the 
disease is contracted through drinking water, the girls would be infected 
as well as the boys, as, though the girls rarely bathe, they, in most cases 
drink the same water. 
Moreover, when travelling among the natives on the East Coast, 
where both sexes di’ink the same water, and both bathe to about the 
same extent, I noticed that the women seemed, if anything, more 
commonly infected than the men; certainly the most severe types of 
the disease occurred among females. I was constantly requested to 
give medicines for women who were passing blood in their urine. 
