84 
Bilharziasis 
I have confined myself to the disease as met with in Natal, where it would 
seem that it is contracted in every instance from bathing in infected rivers 
and stagnant pools. Since the danger of bathing in these places has become 
known, and since the municipalities have filtered or strained their town 
water-supply, the disease has become very much less frequent. I have treated 
cases from Rhodesia which have presented the same symptoms as those with 
which we are familiar in Natal. 
Treatment consists in the avoidance of re-infection from fresh-water 
bathing-places and in combating the complications that arise in the severer 
cases. The disease as generally met with is not a very serious one and its 
interest lies largely in its relation to Life Insurance. 
HISTORY. 
Bilharziasis has existed in Africa for many centuries. Specimens preserved 
from the Xllth dynasty, which is estimated from 2500 to 4000 years before 
Christ, are said to prove its existence at that period. The cause of the disease 
was not known until 1852, when T. Bilharz published the report of his 
discovery of a bisexual distome and successfully established a definite relation¬ 
ship between this trematode worm and the symptoms of dysentery and 
haematuria, which result from its presence in the human subject 1 . In 1864, 
J. Harley reported that the endemic haematuria, common to certain parts of 
Natal and the Cape of Good Hope, was also due to a species of Bilharzia 2 . 
In 1871 he published his attempts to obtain direct infection by the mouth in 
two young rabbits and two dogs; but no trace of Bilharzia could be found 3 . 
In 1872 T. S. Cobbold published an article on “The Development of Bilharzia 
haematobia,” showing how he had endeavoured to trace the life-cycle through 
an invertebrate intermediary host 4 . He failed to induce the ciliated embryos 
to enter the bodies of different species of Planorhis and other fresh-water 
molluscs, but the experiments were undertaken in England. In 1888, Jas F. 
Allen, of Pietermaritzburg, reported “nearly all the youths bathing in the 
Umsindusi and Dorp spruit were infected; whilst the girls, who do not bathe, 
remained free from the disease 5 .” This view of infection by bathing is com¬ 
monly held by all general practitioners in Natal with any experience of the 
disease. 
In a popular lecture to the Rhodesia Scientific Association in Jan. 1914, 
Sir Patrick Manson said, after briefly outlining the development of the liver- 
fluke, “In a similar way I believe the germ of Bilharzia disease, so common 
in this country, especially in young people, and probably contracted whilst 
bathing in pools and rivers, is acquired and spread.” 
1 Zeitschr. f. wiss. Zool. iv. pp. 53, 72-76, 454. 
2 Med.-Chir. Trans. London, xlvii. pp. 55-72, 2 pis. 
3 Ibid. liv. pp. 47-62, I pi. 
4 Brit. Med. Journ. n. pp. 89-92. 
5 Practitioner , xl. pp. 310-320. 
