There is a form of li.maturia which is common in some parts of Africa, especially in Egypt and the Cape of Good Hope. The haemorrhage is clue to the presence of the Bilharzia hmatobia (genus Hematocla). This para site is found in the portal and mesenteric veins, and in the kidneys and urinary passages. According to Dr. James F. Allen, almost every boy in Natal suffers or has suffered from this parasite, for the embryos develope in water and abound in the running streams. The girls, who stay more at home and drink filtered water, commonly escape. The creatures enter the system by the stomach from drinking the water, or by passing directly into the bladder through the urethra while the boy is bathing. Amongst the natives of South Africa a practice is said to prevail, before entering the water, of tying a piece of tape round the end of the penis to prevent the entrance of the parasite.
The haemorrhage appears to come from the bladder. After micturi tion a little blood is passed from the urethra. The quantity is often only a few drops, but may reach several ounces. It occurs on each occa sion at the end of the flow of urine. Its passage is nearly always accom panied by a rigor, and sometimes by pain and irritation referred to the bladder. On examination of the urine it is found always to contain blood, more or less albumen, and a quantity of mucus. In severe cases its reaction is alkaline, and it contains triple phosphate crystals. Under the microscope the ova of the bilharzia are seen entangled in the blood clots and free among the blood-corpuscles. They are i 7 inch long, ovoid in form, and have a spike at one extremity. If the ovum is broken under the microscope, by pressure of the two glasses against one another, the living embryo may be seen to emerge from its shell. It is ovoid in shape, like the egg, is pointed at one extremity, and projecting from the sides are innumerable cilia, which seem to be always in motion.
The result of the constant loss of blood soon manifests itself. The boy, although tall, is pale and narrow-chested. He has little appetite, is listless, and shows no energy, either mental or physical. Children are said to begin to suffer from the parasite at a very early age ; but soon after puberty the ceases and the patient recovers. It appears never to be fatal.
Dr. Allen states that internal treatment of every kind, although it may destroy the parasite in the blood, fails to influence the local symp toms or arrest the hinorrhage. To do this local treatment is necessary. He advises the injection into the bladder of a saturated solution of san tonine in absolute alcohol. Of this, a quantity varying from half a drachm
to two drachms must be used when the bladder is empty, and must be re tained as long as possible. The injection sets up a mild cystitis, which should be treated with hyoscyamus and infusion of buchu. If the larger quantity of santonine be used, the patient feels drunk from the remedy affecting the brain, and the cystitis lasts three or four days, instead of merely one or two ; but no other ill effects are noticed. The injection may have to be repeated several times, but is invariably successful in the end.
Afterwards santonine should be given by the mouth to destroy any em bryos remaining in the blood.
Besides santonine other local applications have been suggested. Iodide of potassium and the liquid extract of male fern are both well tolerated by the bladder. Dr. John Harley recommends a drachm of the fern ex tract to be diluted with barley-water and injected into the bladder. Iodide of potassium may be used of the strength of fifteen or twenty grains to the fluid ounce. Dr. J. Wortabet speaks in favour of the in ternal administration of oil of turpentine, and records a case in which a complete cure was effected by drachm doses of this remedy.
Retention of urine is not very common in young children. It may, however, be induced by mechanical causes. Thus, some little boys have a very long prepuce, with a narrow opening, through which the urine is forced with difficulty. This extra-urethral stricture forms a great obstacle to the complete emptying of the bladder, and may be a cause of serious injury to the health. Cases are occasionally met with in which dilatation of the bladder, ureters, and pelves of the kidneys have been induced by such long-continuecl retention and pressure. Another common consequence of the straining efforts which usually accompany the attempt to evacuate the bladder is prolapsus ani. Retention of urine may also result from the presence of a calculus, which, becoming impacted in the urethra, pre vents the passage of water from the bladder. I have even known such an accident to lead to rupture of the membranous part of the urethra, and extravasation of the urine. Again, irritation of the rectum by worms may be a cause of spasmodic retention of urine. Violent blows upon the lower part of the abdomen may produce a temporary paralysis of the bladder and retention. Lastly, in some cases of febrile disease, such as typhoid fever, we occasionally find distention of the bladder from atony of the muscular coat.