PART III.] Association of the Parasite with Elephantoid Disease. 551 



uncomplicated by any other known morbid condition, and may serve as types of 

 the class in which the urinary tract appears to be the only portion of the economy 

 whose functions are disturbed. 



2. There is, however, another class of cases characterised by the exudation of 

 nutritive fluid into the sub-cutaneous tissues, the fluid either accumulating and 

 forming pouches under the skin and subsequently becoming exuded through orifices 

 more or less minute, or retained until artificially evacuated to allay the pain caused 

 by the tension produced on the surrounding tissues — which are generally in a state 

 of hypertrophy. This affection has long been looked upon as intimately related to 

 Chyluria, and, as already remarked, I considered it probable that the Filaria sanguinis 

 hominis would before long be found associated with it as well as with Chylous urine. 

 This inference I have since shown to be perfectly correct, so that now not only the 

 pathology of these maladies, but the etiology also, is linked together by this parasite 

 being found in the circulation of persons labouring from both classes of diseases. Dr. 

 [now Sir Joseph] Fayrer, who probably has seen more cases of an elephantoid nature 

 than any one living, has suggested the possibility of such an occurrence in his 

 recently published work ;* and Dr. W. J. Palmer, in an essay on some of the 

 common forms of our local skin diseases, has expressed a somewhat similar view.t 



The two classes may, however, be present in the same person, the urinary 

 tract being previously affected in some cases and the sub-cutaneous tissues subsequently ; 

 whereas, in other cases, the Chylous urine symptoms may not be manifested for years 

 after the advent of the elephantoid. 



The first occasion on which I was able to satisfy myself on this point was towards 

 the end of 1873, when through the kindness of Dr. Ewart I was able to examine 

 some whey-like urine, highly albuminous, and exhibiting a tendency to coagulate. 

 The patient, a Jew, was suffering from acute pain produced by an inflamed condition 

 of a moderately large scrotal tumour. This tumour had been coming on for many 

 years, and increased and diminished in bulk at irregular intervals. It was studded 

 with tubercular prominences, soft and yielding to the touch, and when a trocar was 

 introduced several ounces of a sanguineous fluid were withdrawn. This was, however, 

 not found to yield sufficient relief, so that a more formidable operation had subse- 

 quently to be resorted to. The urine also contained occasionally a little coagulated 

 blood in addition to the Chylous fluid, and Filarice were detected in it on the two 

 occasions on which specimens were examined microscopically by me.t The Chyluria 

 had only been observed about a fortnight previously, 



* Clinical and Pathological Observations in India : London, 1873. '- 



t Indian Medical Gazette, Vol. VIII, 1873. 



X Considerable difficulty was experienced in detecting the Filaria in this case. It required fully Jive 

 hours of steady application to the microscope before a single specimen could be found, although they were 

 subsequently found without much difficulty. In the reprint of the former paper on this subject in the 

 '• Indian Annals," the following remarks with reference to this matter were introduced as a foot-note : — 



" I cannot avoid availing myself of the opportunity which this case also afEords of reiterating the 



