Associated bilharziosis and primary malignant disease of the urinary bladder, with observations on a series of forty cases

THE main object I have in view jn placing 0x1 record the following series of cases of malignant disease of the urinary bladder, is to establish the comparatively frequent association, in Egypt, of bilharzial and iiialignant disease of the bladder.The experience I have gained in Cairo during the last six years has impressed me, in this conncction, with the fact that, in the male, malignant disease of the urinary bladder is distinctly more common in Egypt than elsewhere.I an1 driven, for reasons which will be detailed later, to associate this with the prolonged irritation, in large numbers of the population, of the epithelium lining the bladder by the presence beneath it, and the passage through it, of the ova of Uilhamia lzmnntobia.The proportion of the agricultural ('I fellah ") population of Egypt infected with bilharzia is very great.My own observations in the post-mortem rooin have revealed the existence of the disease in 40 per cent. of G O O male subjects from 5 years of age upwards.It is certain, however, that an even larger proportion of the male population harbour calcified ova in their pelvic viscera, as well as in other organs, indicating the occurrence of a long antecedent infection.I n such cases the manifestations at the autopsy of actual disease in the bladder or rectum may be extremely slight.The ova, when scantily present, are easily demonstrated by digesting small portions of tissue for two hours or more in a 5 per cent.solution of caustic soda The softer portions of the tissue are softened and disintegrated by the alkali, and any ova present, especially if calcified, fall as a fine granular sediment.After carefully decanting off the supernatant fluid, the sedimented matter may be conveniently examined in a Petri capsule with a low power (l+ inch)