Case of chyluria with complicated nerv ous symptoms (hysteria) the cause of which Wa S made clear by the expulsion of rt specimen of En8trongillor.c. gigas nine centimetres in length and four milli metres in diameter. Pasquale Moscato (Riforma Medico., Sept. 26, '93).
Case in a man, 57 years old. who had been in Florida for awhile. He can bring on a chyluria by lying down an hour, and more readily if he lies on the back than on the side. The Filaria sanguinis found by Dr. Ernst in his blood. Vickery (Roston Med. and Surg. Jour., Dee. 16, '97).
/ 1. Chylous urine may result from a fistulons communication between tho lymphatic and urogenital system. 2. It may also be due to lipmnia, the kidneys secreting a fatty urine. 3. Tropical ehy luria is always parasitic and due to the Pilaria sanguinis hominis or Distoma hwmatobium; non-tropical chyluria not dependent on liinemia may be caused by the Eustrongylas gigas and possibly also by Ttenia nana. 4. The pathology of the non-parasitic types is not known, but these may depend on tumors, peritoneal adhesions, etc. 5. Certain peculiarities of the non-tropical disease—such as the absence of sugar in the urine, the oc currence of periodical attacks, and the varying composition of the urine during the twenty-four hours—require further explanation. W. E. Predtetschensky (Zeits. f. klin. Med., B. 40, H. 1, 1900).
in most cases symptoms referable to the urinary' organs are noticed, such as pains in the lumbar region, along the urethra, etc. Occasionally the urine co agulates in the bladder, causing pain and difficulty during micturition.
Persons suffering from ehyluria may enjoy good health, but generally there is weakness, wasting, with mental depres sion. Tropical chyluria is often accom panied by fever and diarrhcea.
Chyluria follows a very chronic course.
Diagnosis. — Chyluria may resemble pyuria and lipuria; it can be distin guished from both by microscopical ex amination; in pyuria the urine contains innumerable pus-corpuscles; in lipuria the fat is not present in molecular form, but in large drops or in fine needles and • crystals.
Etiology and Pathology.—The tropi I cal, or parasitical. variety of chyluria is the best known, and its etiolog,y has been elucidated by different authors. It has
been observed in the United States, China, japan, Siam, the Isle of France, Brazil, the East Indies, Egypt, Reunion; Mauritius, Australasia, and recently also in Europe in persons who never had lived in tropical regions. Tropical luria is caused by the presence in the blood of the embryos of Filaria SC111 guinis hoininis: a neinatoid worm.
These embryos were first found in the urine by Wucherer, of Bahia, and later also observed in the blood by Lewis. Their natural history has been elucidated by many observers, especially by Manson.
The adult filaria has a length of from 30 to 40 millimetres and is filiforna: the embry-o measures 0.0075 millimetre in diameter and 0.3-1 millimetre in len;fth. Manson found that the parent filaria live in the lymphatics on the distal end of the glands; they are oviparous and their eggs are arrested in the glands and hatched there. The free embryos then pass along the lymphatic vessels and en ter the circulation. Resting in some organ during the day, they circulate with the blood during the night, or, as Mac kenzie has shown, they rest during the sleep of their host, whether it be night or not.
Manson describes four varieties of filaria:— Filaria nocturna, which can be de tected in tlie blood only at night.
Filaria diurna, which is found in the blood during the day only.
Filaria perstans, which is always pres ent in the capillaries.
Filaria Demarquay, not half the size of the ordinary filaria.
diurna and perstans seem to be confined to the western part of Africa, while filaria noeturna is always present in tropical countries and is endemic in some parts of the United States of Amer ica.
Filarke are not more freqnently pres ent in the blood than the embryo of 1?itharzia hamatoUum. Diago (Cronica Medico-Quir0rgica de la Habana,. p. 35. '90).
Study of the blood of about sixty negroes belonging to the different tribes of the Congo States. Embryos of filaria in the blood of the majority of them found. Filaria were also found in the blood of a negro from the Congo who had been living in Belgiinn for six years. Firket (Annual of the Univ. Med. Sci., vol. i, D-20, '96).