PART iii.l Association of Nematode Hcematozoa with Elephantoid States. 553 



states above described. In May last Dr. Kenneth McLeod, Professor of Anatomy at 

 the Medical College, very kindly forwarded for my examination about three ounces of 

 a reddish-brown fluid, emitting a faint, but not disagreeable, odour, of slightly alkaline 

 re-action, and with a specific gravity of r022. After standing awhile the reddish 

 colouring matter partially subsided ; the upper layer assumed a chyle-like aspect and 

 formed an imperfect coagulum. 



This fluid had exuded through minute orifices from soft tubercular elevations on 

 the surface of the scrotum of a native patient. The scrotum is described as pre- 

 senting a sponge-like aspect, especially on the left side, and as covered with yielding 

 prominences from which fluid may constantly be squeezed — a condition which appears 

 to have existed about three years. On subjecting the sediment of this fluid to 

 microscopic examination numerous living Filarice were readily detected. 



Dr. McLeod has published an account of this in a paper entitled " Remarks on 

 Varix Lymphaticus or Nsevoid Elephantiasis," * an essay which is particularly 

 valuable, in that it not only gives a full and accurate description of this case, but 

 in it the literature of the subject has also been carefully collected and analysed. 



With regard to the actual mode by which this leakage of nutritive fluid, 

 whether chylous, sanguineous, or a mixture of the two, is produced, it is impossible 

 in the present state of our knowledge to speak with certainty. Formerly, one of 

 the best explanations of a mechanical nature that could be suggested was that of 

 interruption to the flow of the nutritive fluid by the presence of tumours acting 

 directly by pressure upon the lymphatics, or the smaller blood vessels, or indirectly 

 by pressure on nerves, and thus interfering with the nervous supply of the part. 

 The intermittent character, however, of the malady and its recurrence after long 

 intervals of absence could not be explained in this way. One of the classes of the 

 disorder, namely, that in which the sub-cutaneous tissues are aff'ected, might possibly 

 have been explicable by some such supposition as the lesions once produced — the 

 diseased action once established by interference with the nutrition of the part — might O 



become permanent. The repeated recurrence of Chyluria, however, at irregular /''  

 intervals, would allow of no such simple explanation. And here I fear that Dr. 

 Vandyke Carter's ingenious " regurgitation " theory, as well as Dr. William Roberts's 

 highly original theory of hypertrophy of the lymphatic tissue with subsequent 

 acquisition of gland properties, would, in the ordinary run of the disease, as seen 

 in a tropical climate, equally fail us. Nor would, indeed, the exacerbations which 

 various elephantoid maladies frequently manifest be easily explicable on any such 

 assumptions.t 



* Indian Medical Gazette, August 1874. 



-j- It would be interesting to know whether the hsematuria of Egypt, Brazil, etc., present similar, well 

 marked exacerbations, especially as this disease is one well known to be associated with a parasite — the 

 Bilharzia h(ematobia of Cobbold. Latterly, moreover, the hasmaturia of Egypt has been found to be 

 associated with the existence of a microscopic nematode in the blood, for Dr. Sonsino discovered two 

 specimens in the blood of a young Egyptian Jew last February. In a communication just received from 



o 



