ETIOLOGY AND PATHOLOGY - CHYLURIA.
There can be no doubt that the evidence at our command allows of a division of chyluria into parasitic and non-parasitic varieties ; and the knowledge that we now possess of the parasitic form enables us to surmise the causes for the non-parasitic group.
Parasitic Cases. —To make the etiology clear it is necessary to give a brief account of the lnematozoon—the filaria sanguinis homi nis, which has a definite causal relationship to chyluria. For a fuller review of this microscopic nematoid entozoon the reader is re ferred to the article on parasites.
The explanation now generally accepted for the appearance of chyle in the urine was first put forward by Dr. Vandyke Carter in 1861. Dr. Vandyke Carter advocated the view that a direct communication existed between the chyle-carrying vessels and the urinary tracts. This, which was in 1862 a theory, is now a certainty, for the parasite which induces such widespread changes in the lymphatic system has been discovered, and a multitude of observations have been made in recent years upon diseases allied to chyluria, such as lymph scrotum, lymph hydrocele, craw-craw, etc., which prove that the escape of chyle through abnormal channels is due to some direct communication between dilated lymphatics and the surface. My dissection of Dr. Mackenzie's patient (see below), and the discovery of the dilated lymphatics and blocked thoracic duct, moreover, leave no doubt but that the cause of the appearance of chyle in the urine is the accidental communication between the chyle-bearing vessels and some part of the urinary tract.
The part played by the parental worm (filaria sanguinis hominis) and its embryo : In 1866 Wucherer, of Bahia, discovered the embryo filarice in chyl ous urine, several of them being in active motion. In 1870 Dr. Lewis, of Calcutta, being ignorant of Wucherer's discovery, found in chyluric urine numerous living nematoid worms, and in 1872 this in defatigable worker discovered the same entozoon in the blood of a Hindoo and in the blood of a chyluric 'patient.
In 1875, O'Neill found the embryo nematodes in the exudate from the skin in a disease known to the negroes of the West Coast of Africa as "craw-craw." The next step was taken by Dr. Bancroft, of Bris bane, who in 1876 detected filarim in the blood of a little girl, aged ten, who was suffering from chyluria. Dr. Roberts, of Manchester
(now Sir William Roberts), and Dr. Cobbold discovered in a speci men of this blood, which Dr. Bancroft sent to him, a solitary and empty egg-shell--a direct proof of the belief already entertained that the filaria was the larval stage of some larger nematoid worm.
In 1876 Carter, of India, found the parent worm in a lymphatic abscess and hydrocele of the spermatic cord. Dr. Bancroft an nounced the discovery of the parent parasite in a letter to Dr. Cob bold, dated April 20th, 1877. It was a dead female obtained on December 31st, 1876, from a lymphatic abscess of the arm. Later on he obtained four living females from a chylous hydrocele. In 1877 Dr. Lewis discovered two living helminths, male and female, from a case of nmvoid elephantiasis of the scrotum.
In 1880 Dr. Manson, of Amoy, discovered the parent worm, a mature female, in lymph scrotum. Dr. Manson now advanced the view that the lymphatics, more frequently the distal vessels, are the chosen and natural habitat of the adult nematode; that the female lying in a lymphatic duct emits her young, which are carried into the lymph current to the lymphatic glands, and having a diameter about equal to the lymph corpuscles, aided by the power afforded by their own vigorous movements, they readily enter and traverse the gland tissue. Thus they pass gland after gland, and emerging into the effer ent vessels are borne along the stream until the thoracic duct is reached, when they finally enter the blood itself (Mastin, "Annals of Surgery," Vol. VIII., p. 31, 1888).
Both Bancroft and Manson suspected there was some intermediate host, and Manson in 1878 discovered the embryo in the stomach of the culex mosquito. Subsequently he found that it was the female of a particular species of mosquito which performed the office of in termediary host. Dr. Manson demonstrated that the female of this special variety, penetrating the skin of a filarial subject, gorges herself with the blood of the victim of her attention, and, as it is usually at night when she makes the attack, with the filarim which are then circulating in the blood current of this individual.