204 Bilharziosis in South Africa 
normal, but within a few hours falling to subnormal and remaining so 
until death. 
A post-mortem examination usually showed that all the organs 
except those of the urinary system were healthy. But the kidneys 
were in a state of profound hydronephrosis, the organs being mere 
shells. 
Urinary Fistula. 
In accounts of the disease by Egyptian observers fistula is noted as 
a common complication. 
The number of natives I see suffering with fistula is small. I have 
never seen one which I suspected was due to Bilharziosis. But most of 
my patients are adult males in the prime of life; the condition may be 
more frequent among the old men, unfit and unlikely to seek for work 
away from their own country, though when I have been in the kraals I 
have not noticed an abnormal number of perineal complaints. 
Of the many complications which must occur when the parasites 
attack the genito-urinary organs of the female I have had no experience. 
Intestinal Bilharziosis. 
The symptoms of this condition in my experience are exceedingly 
indefinite; they are most liable to be mistaken for those of chronic 
diarrhoea or dysentery. 
Those cases I have diagnosed during life have been identified more 
by the exclusion of other diseases than anything else. Because though 
I make microscopical examinations of the faeces, the number of ova 
found in the specimens often did not convey any correct impression as 
to the extent of the disease. It seems that the ova really causing the 
mischief are those working in the tissues. One may even, in severe 
cases of Bilharzial infection of the intestine, experience a little difficulty 
during life in demonstrating the ova, though after death a scraping 
from the mucous membrane of the rectum shows the tissues to be 
infiltrated with them. 
This peculiarity of the disease accounts for it not being more often 
recognised when examinations of faeces are made say for the ova of 
Ankylostomum duodenale. When I see a patient suffering from chronic 
diarrhoea passing five to six motions daily without much slime or 
blood, and not responding to ordinary treatment, but wasting and 
becoming anaemic to a degree quite out of proportion to the extent of 
