F. Gr. Cawston 
89 
I am not aware that Bilharziasis has been demonstrated in any animal in 
South Africa, except in man. Dr Leipoldt, the Medical Inspector of Schools 
in the Transvaal, tells me that he has not succeeded in infecting guinea-pigs. 
However, he is certain that the house-fly carries the egg from the urine and 
that it can infect monkeys in this way, but, in view of the recent observations 
reported from Egypt on the life history of both forms of the parasite, this 
opinion would seem to be of little importance. 
PROGNOSIS. 
The duration of the disease is extremely variable. In the milder cases 
there is seldom any pain and the slight haematuria is not noticeable for more 
than a few weeks. In others, the disease runs a very protracted course, 
extending over many years. Many cases recover and show no after-effects 
from the disease, but sterility is common amongst patients who have suffered 
severely in their younger days. Even in its severest forms, Bilharziasis as 
met with in Natal seldom proves fatal; although, when complicated by an 
attack of cystitis or renal stone, fatal symptoms may and do occur. Favour¬ 
able symptoms are—an absence of anaemia and renal colic, an absence of 
mucus in the urine and only slight and occasional haematuria. Renal colic 
is common and does not necessarily point to the presence of renal calculus; 
it is almost certainly due to the accumulation of ova in the kidney substance. 
These ova have become loose in the blood-stream and have not made their 
way up the ureters from the bladder, as popularly supposed. 
The occasional presence in the urine of blood and mucus, or of shreds of 
mucous membrane, indicates the need for urinary antiseptics and diuretics, 
if permanent damage to the bladder-wall is to be avoided. Microscopic 
examination of the urine will often reveal the presence of ova, even though 
the absence of symptoms of the disease for several years had indicated that 
the patient was cured. In one Government School in the Transvaal, Rusten- 
burg, between 30 and 40% of the boys showed symptoms of Bilharziasis; 
microscopic examination of the urine revealed the fact that 76 % of the boys 
were infected. It is probable that the eggs will continue to escape from the 
body for some months after the worms themselves are dead. Occasional 
aggravation of symptoms in patients indicates that they continue to harbour 
parasites in the blood-stream, even though they have not exposed themselves 
to fresh infection for manv vears. 
J •/ 
LIFE INSURANCE. 
• 
In course of conversation with the Resident Manager for Natal of the 
National Mutual Life Association of Australasia, he stated that the Companv 
would not accept a case of Bilharziasis so long as the disease was sufficient to 
produce albumen in the urine. This attitude is a commendable one, for one 
could not say for certain whether the presence of albumen was entirely due 
to the disease of itself. But this statement was of especial interest in view of 
