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the diarrhoea, I suspect Bilharziosis. I do not wish to infer that my 
patients never pass blood or slime in their motions but, as a general 
rule, they have not done so; their motions recall those of a patient 
with acute tuberculosis, complicated with diarrhoea. 
Straining and tenesmus have not been marked features of the 
disease, though ODe patient was in agony for several days before death 
unless under the influence of morphia. I particularly lay stress on the 
absence of these symptoms, because I note in other countries they are 
reported as being marked features of the disease. It may be interesting 
to note here that, though I have experienced some most virulent 
epidemics of dysentery among natives, attended by a very heavy 
mortality, tenesmus, which is most frequently a very trying feature of 
the disease when Europeans are attacked, was comparatively uncommon 
among my coloured patients. 
Temperature. 
The temperature in intestinal Bilharziosis cases under my notice has 
been, as a rule, normal or subnormal, varied at intervals of seven or 
eight days by a two or three days irregularity. This disturbance may 
have been of malarial origin; at the same time I suggest it may have 
been due to a crop of embryos or miracidia having burst from the ova 
into the tissues. 
Duration of the Disease. 
In Cape Colony and more southern parts of South Africa one 
generally expects the symptoms to abate and finally disappear when 
the patient reaches to about twenty years of age. But that the disease 
may persist for a long time without any re-infection occurring is proved 
by Maj. Freeman (ill. 1907, Journ. Roy. Army Corps, vol. vin. p. 278) 
who quotes the case of a soldier who was infected in Pretoria and 
afterwards returned to England. Three years after his return, living 
ova could still be found in his urine. I am inclined to think it doubtful 
whether a person, once he has contracted the disease, and the walls of 
his bladder and the surrounding tissues have become impregnated 
thoroughly with calcified ova, will ever be completely free of all 
evidences of the complaint. I think that years after all active mischief 
has ceased, scraping of the bladder tissue would still show calcified ova, 
or their debris. That is to say, the ova can be demonstrated long after 
the actual trematode producing them has been destroyed and absorbed. 
