10 



On the inunung of August 10 the patient was given an ounce of 

 magnesium suli)hate and her stool carefully examined for signs 

 of intestinal parasites. Nothing but a few ova of Trichocephalus 

 dispar was found. We l^elieve that trichinosis can be excluded 

 and are not aAvare that the eosinophilia can lie influenced by the 

 Trichocephalus dispar which the patient harbors.' 



According to Manson (6) the presence of blood in the urine in 

 such cases is not due t(j the rupture of blood vessels but to "the 

 formation of blood corpuscles in the lymph long retained in the 

 varicose vessels." Our failure to alter the sanguineous character 

 of the urine by the administration of adrenalin, locally and by the 

 mouth, seems to support this idea. On the other hand, the 

 development of antemia and the presence of a few normoblasts in 

 the peripheral circulation would seem to indicate that at least a 

 portion of the loss occurred through capillaries torn during the 

 rupture of dilated lymph vessels, as is suggested by Scheube (7). 



(3) The embryo nematode has been well described b}' Manson, 

 and our own study has been greatly influenced by his excellent 

 descriptions. A brief description made on July 30 may be 

 inserted here: 



A fresh preparation was made at 10 p. m., ringed with vaseline 

 and a filaria watched for some time. It underwent the usual 

 movements of coiling, uncoiling, and sliding forward and back- 

 ward within its sheath. At about the junction of the middle and 

 posterior thirds there could he seen an irregularly elongated 

 viscus-like organ, which seemed to be composed of a granular 



iRemlinger (4) (Constantinople) has recently noted an eosinophilia of 48 

 per cent in a case of multiple infection with the Medina worm. He says: 

 "EUe est egalement a rapprocher de I'eosinophilia observee la Filaria 

 sanguinis hondnis, la Filaria Loa, la Filaria Imitis, du Chien, etc." 



Manson (5) has expre.ssed the belief that a large number of filarial 

 embryos in the peripheral circulation indicates a multiple infection with 

 adult parasites. Apparently there is no definite information as to the fate 

 of the embryos, but Bancroft computes their life duration at a few months. 

 To our knowledge they have not been observed in the dead condition in 

 the blood of man except when killed by some form of medication, as in 

 Scheube's case, which was treated with picric-nitrate ot potash. It seems 

 possible that thej- maj- accumulate in the blood, and, if so, large numbers 

 would merely indicate that the case was of long standing. The grade of 

 eosinophilia, together with an enumeration of the emliryos by the method 

 of Lathrop and Pratt, especially if supported by a post-mortem or post- 

 operative search for the adult parasites, would throw light on this point. 



