It has not yet been proved in what manner the embryos of the filaria give rise to chyluria, but it is commonly be lieved that the parasites obstruct the lymphatics and cause their delicate walls to rupture, or that they perforate the walls of the chyliferous vessels and bring about abdominal communications.
It has already been mentioned that chyluria presents an extremely varied clinical history and may be accompanied by divers other symptoms, such as chy lurious discharges from various parts of the body, with elephantiasis, lymphan giectasis, etc.
The diversity of the clinical manifesta tions may, perhaps, find its explanation by the fact that it is not always caused by the same species of filaria.
The non-tropical variety of chyluria is not of parasitical nature, and its origin is, as yet, quite obscure; it occurs even in cold climates, but is a very rare dis ease.
Case of ehyluria occurring in a woman aged 67 years. The symptoms developed during an attack of croupous pneumonia of the left lower lobe, on the ninth day of the disease. The urine resembled much the appearance of coffee weakened by a large excess of milk. No filarim were found hi the blood. Wellla,u (Med. Record, Feb. 15, '90).
C'ase of chyluria observed in a boy of 11 years, who had never left the town of Riga, Russia. Bernsdorf (Annual, vol. I. F-43, '95).
Manson's observations seemed to show that the embryos were taken along with the blood in the stomach of a certain form of mosquito in which they undergo developmental changes. After some days the mosquito discharges its eggs in the water of some pool and the filaria there becomes free, and by this medium the animals are conveyed to the human sys tem, through drinking the water.
Mosquitoes seem to be the active agents by which the disease is propa gated. The mosquito bites a, man or an animal affected with the filarial disease. The Maria curls itself around the pro boscis of the mosquito, is sucked into the stomach of the insect, passes into its tissues, grows, and develops there. When the mosquito dies the worm is set free, and, getting into drinking-water, is again introduced into the human subject through the stomach and alimentary canal. Byrom Bramwell (Brit. Med. Jour., July 31, '97).
In some cases very small drops of fat have been observed to circulate with the blood and to be discharged through the kidneys; in some instances the authors favor the belief that the urine is secreted in its normal state, but that the fat is added during its passage through the ureters and the bladder.
Prognosis.—Chyluria is ordinarily a disease of long duration. Sometimes the patients recover spontaneously; in other cases it leads to amemia and severe diar rhoea and the patient dies from exhaus tion.
Treatment.—Medicine seems to have but little influence on chyluria. Rest. crood nutritious diet which is not too exclusively animal, the use of pure water for drinking purposes, iron, and quinine have been recommended, as well as large doses of iodide of potassium. .Against
the parasitic chyluria anthelmintics have been tried, as methylene-blue (Austin Flint, Annual '96, vol. i, D-80) and thy mol (Crombie, Annual, '96, vol. i, D 81). In the tropics a plant—pentaphyl lum—is much relied upon; mangrove bark is considerably used in Guiana.
Case of filarial chyluria in whom, other treatments having failed, thymol was ad ministered in 1-grain doses every four hours, this dose afterward being doubled. Under this medication the filarim disap peared after a few weeks from the blood, and the urine gradually improved until in about two months it had resumed its normal character. Two months later no recurrence of the pathological condition had taken place. Lawrie (Indian Med. IZec., Afar., '90).
Alethylene-blue tried in a case of chy thrift due to the filaria sanguinis hom inis. The effects of the drug were de cided and prompt. After the administra tion of 2 grains every four hours dur ing the day, on March 5th, the parasites were very few at 11 rm.; the only two found were deeply stained with blue and their movements were extremely slug gish, the urine being clear, but intensely blue. On the fourth and the seventh days no parasites were found, although the treatment had been discontinued after the first day. On the eighth day the urine became Junky, and on the night of the ninth day the parasites were found in great number, but their movements were not very active. On the tenth day the treatment was resumed and contin ued for five days. Three days after, the blood being, examined at night, a very few motionless filarim were observed. Since that time, and up to the present writing (more than a year), the urine has been normal and the patient has been restored to perfect health. Austin Flint (N. V. A1ed. Jour., June 15, '95).
Case of chyluria, the first of the kind observed in Philadelphia. Aficroscopical examinations of the blood drawn from the finger showed that the parasites were very few in number or absent from the blood during the day; they were, there fore. the variety known as the Filaria nocturna. Methylene-blue in 2-grain capsules every three hours was ordered. After being taken continuously for sev enty-two hours the blood was found to contain actively-moving unstained fila rim. The urine and fmces were stained a deep blue; the milk was uncolored. After being taken for nine days the drite. proved absolutely inert so far as any in fluence on the vitality the embryos was concerned, and it did not stain them until they were dead. F. P. Henry (Med. News, May 2, '96).
TWO cases of chyluria in which re covery took place rapidly under the use of ichthyol in daily amounts of 7 or S _-2.ains, in the form of pills. Aloncorvo (Nouveaux Remedes, Dec. S, '97).