90 
Bilharziasis 
the fact that I had recently advised a further examination of an applicant 
whose urine contained a slight trace of albumen. Later, I heard that the 
applicant had suffered from Bilharziasis, and a subsequent examination of 
the urine revealed the piesence of ova containing miracidia. The Manager 
stated, further, that the Company would accept at the usual rates for Life 
Insurance persons with a past history of the disease whose urine was free 
from albumen. 
The Manager for Natal of the Southern Life Association did not consider 
a history of Bilharziasis in the past very unfavourable, but he drew attention 
to the risk of gonorrhoeal infection in patients with a past history of the 
disease. 
If an applicant for Life Insurance had noticed no symptoms of the disease 
for the last twelve months and occasional examination of the urine during 
the last six months had shown no presence of ova or other abnormality, I 
should recommend a Company to accept the case without a loading. 
If examination of the urine revealed the presence of ova, I should advise 
a fresh examination in three months and not advise that the case be accepted 
until the urine had been clear for six months. 
If renal colic had been severe and frequent, albuminuria present, a low 
specific gravity of the urine which is a not uncommon after-effect of the 
disease, or other sign of permanent kidney mischief, I would naturally advise 
refusal of the applicant. 
The following opinions of Natal practitioners given in 1893 and 1906 in regard to the 
seriousness with which Bilharziasis should be considered in its relation to Life Insurance is 
instructive, and it is interesting to note how little they altered their views, after further 
experience of the effects of the disease. In one case, only the opinion expressed in 1893 can 
be quoted: 
1. Have you had any death attributable to Bilharziasis? 
Dr. A. 1893 (after eight years practice in Natal and Cape). No. 
Dr B. 1893 (after ten years practice in Natal). No. 
1906 (after twenty-three years practice). From secondary effects, but extremely 
rare; I know of two cases onlv. 
Dr C. 1893 (after ten years practice in Natal). No. 
1906 (after twenty-three years practice). No. 
Dr D. 1893 (after ten years practice in Natal). No. 
1906 (after twenty-three years practice). No. 
Dr E. 1893 (after ten years practice in Natal). Yes, indirectly. One case at P.M.: examina¬ 
tion showed kidneys congested and deposits of gravel. Patient had suffered from gravel, 
albuminuria and renal colic. Ova were numerous and I attributed death to Bilharzia. 
1906 (after twenty-three years practice). Not directly. 
2. Have you had life shortened by this affection? 
Dr A. 1893. In one case only, which I attributed to chronic cystitis, due to Bilharzia. 
Cystitis began at age of 10 years. Death occurred with convulsions at age of 16 years. 
P.M. examination showed much inflammation of the bladder, but no examination for 
Bilharzia was made at time of death, nor for two or three years before then. 
