CHYLURIA 85 



most commonly these worms when dead calcify. In a 

 considerable proportion of the cases the worms were in 

 the connective tissue in the hilum of the kidney. 



It is not improbable that further investigation will prove 

 that in addition to the obvious and striking manifestations 

 of filariasis, a much graver condition may be present, 

 and owing to the disorganization of the lymphatic system 

 (whether there is obstruction or merely dilatation of the 

 lymphatic vessels), one of the main lines of defence against 

 invasion of tissue and multiplication of micro-organisms 

 in the blood is impaired. Possibly also the stagnating 

 lymph has lost its bactericidal powers. Observations on 

 the bactericidal powers of healthy lymph and of those of 

 the lymph in these dilated lymphatics are required. 



Chyluria. A rather striking manifestation of the disease 

 is chyluria, or haematochyluria. In this condition the 

 urine is milky-white in colour, sometimes tinged with 

 pink, and sometimes containing blood-clots or mixed 

 with blood. Rarely the blood is so abundant that the 

 urine is red in colour and looks like blood. 



The urine in these cases varies from time to time ; there 

 may be long intervals when the urine is normal. Fre- 

 quently, even during the period when the urine is 

 abnormal, it will be normal when the patient is at rest 

 in bed, so that the first urine passed in the morning may 

 be quite clear, that passed when he has been up slightly 

 milky, becoming more milky or perhaps tinged with blood 

 later in the day. Such a patient, after violent exertion, will 

 often show a marked increase in the amount of blood 

 passed. 



Filarial embryos may be found in the chylous urine at 

 any time of the day or night. Frequently the embryos 

 are more abundant in the blood-clot, and they are also 

 often found adherent to any threads that may be present 

 in the urine. 



The urine, when allowed to stand, coagulates, some- 

 times forming a jelly-like mass; in other cases, where 

 there is less chyle, coagulation is partial, so that shreds 



