552 Pathological Significance of Nematode Hcematozoa. [part hi. 



The next case, for which I am indebted to Dr. Coull Mackenzie, was that of an 

 East Indian 35 years of age. Unlike the preceding, the scrotal affection was of short 

 standing, nine months only, and Chyluria symptoms had not yet set in. When the 

 disease commenced it was looked upon as a hydrocele, and the tumour was repeatedly 

 tapped, and a milky, pus-like fluid withdrawn. The swelling, however, continued to 

 increase, became very painful, and eventually attained the size of a man's head. 

 The patient was admitted into the Presidency General Hospital for " thickening and 

 enlargement of the scrotum." The tumour was twice tapped in hospital, and the fluid 

 removed sent to me for examination. It presented a somewhat purulent appearance, 

 but the odour was not offensive. Under the microscope it was seen to consist of 

 broken-down granular matter, and every slide of it contained some half-a-dozen 

 specimens of Filaria. 



With reference to the above it may be remarked that one of the patients 

 suffering from Chyluria which I described in the previous paper,* and whose blood 

 was shown to be affected with Hsematozoa to an enormous extent, is now manifesting 

 symptoms very like these, the scrotal affection having commenced some two years 

 subsequent to those of Chyluria. Filarise may still be detected in his system. 



The third example of this class of the affection which I had specially observed 

 was that of a middle-aged native, a patient of Dr. McConnell's at the Medical 

 College Hospital. He was suffering from a second attack of Chyluria, the first having 

 come on a year previously and lasting some six weeks. He had an enlarged scrotum, 

 which had lasted some seven years ; but about six months after the advent of the 

 Chyluria his left foot and ankle began to enlarge, and now they present a well- 

 marked elephantoid appearance — a condition which he referred to as " Groodah " in 

 Bengalee. 



About a dozen specimens of blood, obtained by pricking his fingers and toes, 

 were subjected to microscopic examination, and each slide was found to contain two, 

 three, or more specimens. 



I will refer to one more instance showing the intimate connection existing 

 between the presence of these Haematozoa in the circulation and the elephantoid 



fact — for I feel that it cannot be done too strongly nor too often — that the detection of Filance, whether 

 it be in the urine or in the blood, is sometimes a matter of very considerable difficulty. Hours may 

 have to be spent in examining the sediment of apparently excellent samples of Chylous urine before 

 they are found ; fresh supplies may even be required, for the numbers present may vaiy very much in 

 different samples obtained from the same individual; and, as may be learnt from some of the cases 

 narrated above, they may be even absent for a time from either the urine or the blood, or from both 

 — at all events their detection required more patience than I was able to command at the time of 

 examination, whereas, they were obtained with tolerable ease from the same person on subsequent 

 occasions : I have also observed that, occasionally, they will disappear altogether for some time previous 

 to the disappearance of the Chylous condition of the urine. It will therefore be evident that no great 

 amount of foresight is required to be able to predict that, owing to want of proper appliances, want of time, 

 or other circumstances, such remarks as ' Fllarice were searched for, but not found,' will, not infrequently, 

 be recorded in connection with reports of Chyluria cases." 



* Eighth .\nnual Report of the Sanitary Commissioner, Appendix E, page 246. 



