The mosquito, by sucking the blood from a person with this disease, is prob ably connected with the further develop ment of the embryos. It is most likely that some change takes place within the mosquito, which, upon dying, sets free the embryos in some stagnant water where still further development occurs; this, however, has not been proved. Man probably becomes affected through the drinking-water.
Symptoms. — In hamatochyluria the urine passed is white, opaque, and milky, or sometimes bloody with a sediment con sisting of a slightly-reddish clot. The patient may be troubled with this con dition only intermittently, normal urine being passed for weeks between the at tacks. Fat-granules, red corpuscles, and the embryos in the urine are found mi croscopically. Manson attributes some at least of the cases of elephantiasis ara bum to the effects of the In LYMPH-SCROTUM, another condition caused by this parasite, the parts are very much swelled and thickened. The lymph vessels are so distended that they are plainly visible and exude a turbid fluid upon puncture.
filariasis exists, all drinking-water should be filtered or boiled and kept away from mosquitoes. In cases of chyluria the diet should be dry and devoid of fat. Thymol and methylene-blue have both been claimed by different observers to have given good results.
Manson contends, however, that the attempt to cure filaria chyluria by the ad ministration of a parasiticide is founded on a misconception of the true pathology of this disease and the part played by the filaria in its production. The filaria stands to chyluria very much in the same relation as rheumatic fever stands to heart disease and gonorrhcea to urethral stricture; it starts the pathological proc ess, but its constant presence is not neces sary to keep it up. To attempt, there fore, to cure chyluria by trying to kill the filaria is illogical. Once established in the human body, the filaria should be left alone,—protected, rather than per secuted. Pathology indicates that the proper treatment is in principle the same as acquired varix in any inaccessible region. This should be rest, elevation, lowering of the tension in the lymphatic vessels by the use of saline purgatives, limited and appropriate food, and absti nence from fluids as much as possible.
Surgical intervention is sometimes of value in removing the adult filarioe from the enlarged lymph-glands.
Filaria, or Dracunculus, medinensis,— or guinea-worm,---is a thin, thread-like worm from 60 to 100 centimetres in length, of which the female alone is known. The cephalic end is rounded off, while the caudal end tapers to a point. The external covering consists of a firm cuticle; the uterus filled with young oc cupies the chief part of the body-cavity. The embryos have no shell, but merely a thick covering, with a pointed tail. These embryos are received into the human stomach through the intermediation of small crustacea and are swallowed through drinking-water. It is frequently found among the inhabitants of Asia and Africa, developing in the skin, occasion ing abscesses chiefly in the lower extrem ities, especially about the heel.
Treatment.—The symptoms produced by the Dracunculus are chiefly local and little can be expected from internal medication. Oriental practitioners, how ever, secure excellent results from the internal use of asafoetida for a week or more; nitrate of potash, in 2-drachm doses in buttermilk, and the use of sugar candy exclusively is said to cause the death of the worm in one or two days (R. Atmaran).
Local measures and surgical interfer ence are chiefly relied upon by many ob servers. One of the simplest is the use of cold-water affusion. J. C. H. Pea cocke recommends the plan of placing the limb under an interrupted stream of water as soon as the worm has made its external opening in the skin.
The Eustrongylus gigas is a rare para site found occasionally in the pelvis of the human kidney. The female reaches the length of a metre. Several species of the Dochmius occur also in dogs and cats and also produce anTmia. Certain varie ties of Strongylus occur as intestinal para sites or in the lungs, blood-vessels, or other tissues in the domestic animals.
Anguillula stercoralis (or Pseudorhab ditis stercoralis) is a small nematode found in Italy and Cochin China. In Italy it sometimes co-exists with the Anchylostomuni, but produces little harm except an occasional diarrhoea. The para site penetrates the crypts of Lieberkiihn, where it deposits its eggs and young, causing disturbances of the epithelium. The size of the male is 0.88 millimetre; of the female, 1.2 millimetres.