210 
Bilharziosis in South Africa 
have never had a patient presenting the clinical symptoms of calculus 
of the bladder. In view of Egyptian records this experience appears 
extraordinary. 
Bladder. This organ is the one most commonly affected. As 
stated befoi’e, I have only made four autopsies on natives found to harbour 
the parasite, in which the bladder escaped infection. The effect of the 
ova on the coats of the organ varies greatly, according to the numbers 
present, and to the length of time they have had to produce the 
changes. 
In some the only feature noticeable on first opening the bladder is 
a small slightly inflamed spot on its mucous membrane; in others, one 
is at once struck by the presence of several acutely congested papilliform 
bodies projecting into its interior, which would undoubtedly bleed when 
squeezed by the contraction of the bladder at the end of micturition. 
In more advanced cases still, the area of acute congestion is extensive, 
affecting nearly the whole of the internal surface, in the centre of which 
there may be a patch of black gangrenous mucous membrane, easily 
detachable. Such a condition might result in a very large haemorrhage. 
It would appear that the varying degrees of inflammation described 
above represent the sub-acute and acute stage of the disease, and that 
at a later date, when the parasite dies out, or the ova for some reason 
lose their activity, other changes occur, which can be looked upon as 
representing a more or less chronic condition. 
I make this statement, because, in other bladders I have found on 
careful examination faintly coloured brownish spots on the mucous 
membrane, not gritty to the touch, or raised above the surface, in which 
a few terminal spined calcified ova can be found on microscopical 
examination. This condition is, I believe, the chronic stage of the 
sub-acute condition described first, in which there was only very slight 
congestion. 
Following this stage a little further, one finds bladders in which 
there are four to five greyish-brown patches, of about 15 mm. in 
diameter, slightly raised above the surface of the mucous membrane; 
these when scraped with a scalpel can be heard and be felt to be gritty. 
Later still the spots are much more elevated, and have blackened tops, 
which project into the bladder, and resemble warts which have been 
burned with caustic. In other bladders, nearly the whole extent of the 
internal surface is affected. Such bladders when opened and spread 
out, resemble a sheet of very fine sandpaper, and on the surface of some 
of them I have seen small pin-head vesicles, which are hard, feeling like 
