The treatment of urinary bilharzia in Egypt by miracil D

(1) The results of clinical trials of miracil D on S. haematobium infections in Egypt and S. Rhodesia are contrasted and discussed. (2) Further trials in Egypt were designed to reduce the chance of reinfection and preinfection which may have falsified the relapse rate in the earlier trials, and during these, eight patients were treated with miracil A. (3) Miracil A or D was given in a dose of gramme 1 morning and evening for 3 days. The course was repeated at monthly intervals as necessary, the maximum number of courses being three. The cases were followed until 6 months after the first treatment. (4) A method of demonstrating the presence of a very small number of live eggs in a specimen of urine is described and was used as the final test of cure. (5) Twenty-six patients were treated with miracil D ; 10 out of 13 heavily infected patients were cured by two or three courses of treatment, and 12 out of 13 mild cases were cured by one or two courses. (6) Eight patients received miracil A.Four were heavily infected and were cured by three courses of treatment.Three of the other four light infections were not completely cured by two courses and a third course was not given. (7) The use of an enteric coated tablet reduced and frequently prevented altogether the usual side effects. There was, however, much evidence that satisfactory absorption of the contained miracil D did not occur in patients with intestinal disease and consequent intestinal hurry. (8) The citrate and the mandelate of miracil D were found to be less irritant than the hydrochloride, and investigation of other salts is recommended. (9) It is emphasized that work on the miracils as therapeutic agents in bilharzia is still at an early stage. The results so far achieved warrant further laboratory and clinical investigation on a larger scale.