A water snail -> water -> a larval parasite -> and a human host - the course of Bilharzia is as easily traced as it is easily contracted.

Painful and harmful to the human system, Bilharzia is a disease known long ago to the Ancients of Egypt but only during the last hundred years has it made its appearance in Southern Africa.

Its progress since then has been rapid and disturbing; it now flourishes in Rhodesia and Mozambique and indeed in most of the countries of Southern Africa. In the Republic of South Africa it is prevalent in Natal, the Northern Transvaal and parts of the Cape Province and it is still spreading.

To many authorities it appears, too, that the progress of the disease may be measured not only geographically but also in terms of the increasing severity with which the disease is being contracted.

What is Bilharzia? A disease which usually affects the bowel or the bladder - dependent upon which form of the disease is contracted.

What causes it?
Adult worm parasites which live in the blood vessels of the body.

How do the worms get into the human blood stream?
By a changing process in the course of which:

(1) They invade their human host, in the form of a cercaria (minute larval parasite) (see sketch), when the person comes into contact with infected water. (They are usually present in infected water in many thousands.)

(2) The cercaria (which is able to penetrate the unbroken skin) attaches itself to any part of the body and enters it very quickly, taking a few minutes at the most, to pass through the skin. To assist the process of obtaining `house room' from its future host the cercaria has two suckers on its head and a long tail hooked at the end.

(3) As soon as the head of the cercaria has penetrated the skin it discards its tail. Only the head penetrates the skin whence it moves into the blood stream and through the heart and lungs to the liver.

What takes place in the blood stream?
A steady change in the appearance of the cercaria as it travels to the liver. At the end of the journey it is a fully developed adult worm - male or female, ready to pair and mate.

After mating?
The paired worms move to the bladder or bowel and the female lays egg in the tissue of those organs.

What becomes of the eggs?
They pass through the walls of the bladder or bowel and out of the body in the urine or stool. The eggs cause most of the tissue damage.

Do the paired worms always find their way to the bladder or bowel?
No. Some may lose their way and lay their eggs in other organs and these, of course, do the most harm because the body is unable to get rid of them. The hard shells of the eggs (which usually blacken and die after about three weeks) damage the tissues of the organ in which they are lodged. This can happen in the liver, the lungs, the brain and the spinal cord and other organs, with serious effect.

COMPLETING THE CYCLE
The `water' phase.... So far in this text the human phase of the cycle has been traced from its waterborne origin to a changed form in the organs of the body and emission of eggs in the urine or stool. (See diagram of complete cycle page 8). The continuation and completion of the cycle requires that the eggs in the urine or stool be passed into fresh water if the living embryo, the `miracidium', which the egg contains, is to live and complete the cycle.

WHAT THEN?
Once hatched, the miracidium, which is covered with fine hairs that enable it to swim about, will live for perhaps ten to twenty hours. In this brief period it must find an appropriate water snail host or die.

MIRACIDIUM AND SNAIL
Biomphalaria - for bowel bilharzia and Bulinus (Physopsis) - for bladder bilharzia (see diagram page 8) are the only snails acceptable to the miracidium. After locating and penetrating its host, it develops rapidly and a reproductive process sets into motion. As a result of this process, a spore is produced which, for the next six weeks increases and multiplies in the snail; it is then `budded off', in many thousands, into the water.

Cycle complete
The bilharzia cycle is now complete, for the spore, `budded' from the snail, is the `cercaria' parasite - the larva which penetrates the human body.

SYMPTOMS.
It must be stressed that in either type of Bilharzia symptoms may vary from person to person at any stage of the disease. The tell-tale signs detailed underneath, however, should prove a reliable general guide. Also it happens that both forms of bilharzia parasites are sometimes present together in man.

BOWEL BILHARZIA An itchy rash may develop a few days after contact with infected water, or much sooner.	BLADDER BILHARZIA An itchy rash may develop a few days after contact with infected water, or much sooner.	COMMENTS Many people do not develop the rash.
Fever and a cough may develop after two to three weeks. The illness, resembling influenza, lasts for a few days.	Fever and a cough may develop after two to three weeks. The illness, resembling influenza, lasts for a few days.	Caused by worms on the journey to the liver, bladder or bowel.
After some weeks aches and pains in the abdominal area; diarrhoea; there may be passing of blood in the stool.	After some weeks blood is passed in the urine.	These symptoms may vary greatly.
Easily tired - lack of energy.		A characteristic of the disease throughout the later stages.
Other symptoms may occur which will be dependent upon the organ in which the worm is laying its eggs, e.g. liver - liver disease.		The greatest damage is caused by eggs laid in organs other than the bladder or bowel i.e. organs from which they cannot be passed out of the body.
Report to your doctor if there is any reason to suspect Bilharzia infection.

What should be done if Bilharzia is suspected?
Consult a doctor immediately.

Is there any sure sign of the disease?
Yes. The passing of bilharzia eggs in the urine or stool; this sign, however, is not always present in an infected person, and can only be detected on microscopic examination.

What other steps can be taken?
It may be necessary to conduct immunological or blood tests to determine if a person is infected or has previously been infected.

The treatment?
Both bowel and bladder bilharzia are combated by drugs of various kinds which should be used only under a doctor's instructions.
New drugs have been introduced recently which are under test at the moment and show promise. There may however be side effects from their use.

Why is Bilharzia flourishing?
Because the public knows too little about the disease and, as a consequence, far too often:
(i) inadequate toilet facilities are provided at public bathing spots
(ii) pollution, by urine or stools, of streams, rivers and pools by infected persons takes place again and again, completing the cycle (see page 8) and ensuring the spread of the disease.
(iii) the disease is contracted daily by hundreds of persons unaware of the dangers of bathing in infected water.

What measures can be taken against Bilharzia?
1 Avoid bathing in suspect streams, pools or stretches of water. All natural water in an area affected by Bilharzia should be deemed to be infected and contact with it avoided as far as possible.

2 If by mischance a person is exposed to infected water he should dry himself thoroughly as quickly as possible before the cercaria has a chance to penetrate.

3 Adequate toilet facilities should be provided by the appropriate authorities. If no toilet facilities are available, relieve yourself well away from water.

4 The public should be educated and informed through booklets and health campaigns as to the nature and the danger of the disease.
They should be made aware: of the dangers of passing stool or urine into open water; of the necessity to purify water for drinking or washing; of the fact that apparently clean water may nevertheless be infected as th~ parasites are very tiny; and, above all, of the danger of having contact with infected water.

5 Other more far-reaching action in regard to control of waterways etc. may be taken by governmental/provincial and municipal authorities but they lie beyond the scope of this booklet.

OTHER INTERESTING FACTS ABOUT BILHARZIA
* Over 200 million people in the world are infected by this disease.
* The number of children infected far outweighs the number of adults.
* Children do more to pass on the disease than do adults.
* A series of tests done on Secondary School boys in Rhodesia has shown that under 5% of the "bright" Scholars were suffering from Bilharzia, whereas over 17% of the dullest children were infected.
* A person with Bilharzia may have several hundred worms in his body measuring up to 1/2 inch long and laying 300 to 500 eggs per day each. It's the eggs not passed out of the body that are the main cause for concern.

Try to spread the knowledge you have gained about Bilharzia from this booklet. Pass the booklet on, too, to someone who will read it carefully. Remember, every day hundreds more people are contracting Bilharzia through lack of knowledge or carelessness.

Brought to you with the compliments of:
THE OLD MUTUAL South African Mutual Life Assurance Society P.O. Box 66, Cape Town
The health of the nation is the wealth of the nation

(more info about Bill-Harris!)

BILHARZIA

How is one infected with Bilharzia?
At infected person may have many paired worms inside the body, each pair producing two to three hundred eggs per day. These eggs are passed out at the body either in the patients urine or faeces.

For further development of the disease, the eggs must reach fresh water. Once in water these eggs hatch in approximately ten minutes into microscopic creatures called miracidium.

For survival miracidia suet find a suitable fresh water snail in 48 hours or die. They enter the host via soft tissues, to start further development within the host.

In six weeks another form of parasite emerges, called cercariae.
These creatures are barely visible to the naked eye and resemble tadpoles with forked tails. Cercariae must now find a host - being man in water. They penetrate the skin, and make their way to the liver, where they grow into worms measuring one centimeter in length and mate.

They now leave the liver and migrate to the walls of the bladder or colon. On these two sites eggs are laid which penetrate the linings and are passed out of the body in either urine or faeces.

Development takes six weeks.

SYMPTOMS:
People who have Bilharzia usually feel tired and not very well. They sometimes get headaches and abdominal pain. Occasionally blood is seen in the stools and urine.

PREVENTITIVE MEASURES:
1. Regard all natural water as potentially infected.
2. Do not bathe, swim or paddle in infected water.
3. Take adequate precautions when boating or fishing.
4. When camping, picnicking, etc.. boil water that is to be used for drinking, or take a supply of pure water.
5. Use latrines, where possible, to avoid contaminating waters.
6. Dry yourself immediately and vigerously if wet from spray or an accidental contact with infected water.