Schistosomiasis examination. Third World doctor examining the abdomen of a man suffering from intestinal schistosomiasis (bilharzia). The man has an enlarged liver and spleen, distended abdomen and wasted muscles. The disease is caused by flukes called schistosomes whose larvae live inside freshwater snails. When mature the larvae leave their host snail and enter the water. They can penetrate human skin in order to reach the bloodstream where they grow into adult worms. The adults produce eggs causing an influenza-like disease. The eggs, which are passed in the urine and faeces, may infect more freshwater. Drug treatment is effective. Photographed in Sudan.